睾酮伴甲胎蛋白升高的卵巢支持-间质细胞瘤的临床及内分泌特征分析  

Clinical and endocrine characteristics of ovarian Sertoli-Leydig cell tumor with elevated testosterone and alpha fetoprotein

作　　者：仲思怡 孙艳丽 陆小燕 纪捷[1] 陈捷[1] 顾林[1] ZHONG Siyi;SUN Yanli;LU Xiaoyan;JI Jie;CHEN Jie;GU Lin(Department of Gynecology and Endocrine,Women's Hospital of Nanjing Medical University,Nanjing Maternity and Child Health Care Hospital,Nanjing 210004,China)

机构地区：[1]南京医科大学附属妇产医院(南京市妇幼保健院)妇科内分泌科,南京210004

出　　处：《临床肿瘤学杂志》2022年第8期744-748,共5页Chinese Clinical Oncology

摘　　要：目的探讨睾酮伴甲胎蛋白(AFP)升高的卵巢支持-间质细胞瘤(SLCT)的临床及内分泌特征。方法收集2018年1月至2021年12月因异常子宫出血/绝经后阴道流血于本院就诊的经手术病理证实为SLCT患者的临床资料,通过回顾分析其临床资料、性激素指标、影像学表现、肿瘤标志物、手术和病理情况等来筛查睾酮伴AFP升高的SLCT患者,重点分析影像学表现、肿瘤指标、手术和病理结果及术后随访情况。结果5例患者中2例为绝经后女性,表现为绝经后异常阴道流血,另3例为育龄期女性,既往月经规律,无诱因出现月经紊乱。育龄期患者中2例实验室检查提示睾酮伴AFP升高。2例睾酮伴AFP升高者的盆腔彩超均提示左附件区异常回声,盆腔MRI均提示左侧附件区包块,肾上腺B超/CT未见明显异常。肿瘤标志物提示2例患者除AFP水平升高外,其余肿瘤标志物(CEA、CA125、CA199和HE4)均正常。2例病例中1例为卵巢中分化SLCT:瘤组织被分隔呈分叶结节状,小管结构较少,肿瘤细胞以Leydig型细胞为主,细胞类圆形、胞质丰富,嗜酸性,颗粒状;另一例为卵巢高分化SLCT:瘤细胞排列呈腺泡状,小管状,肿瘤细胞以Sertoli型细胞为主,细胞呈高柱状,胞质稀少,淡染,胞核小。2例患者均于术后恢复正常月经周期,1例患者术后2个月复查睾酮为0.5 ng/ml,另1例术后1个月复查睾酮为0.74 ng/ml,2例术后AFP均降至正常范围。结论异常出血患者检查发现睾酮水平异常升高,需警惕分泌雄激素肿瘤可能。少部分SLCT患者伴AFP水平升高,睾酮及AFP可作为术后重要随访指标。Objective To investigate the clinical and endocrine characteristics of ovarian Sertoli-Leydig cell tumor(SLCT)with elevated testosterone and alpha fetoprotein(AFP).Methods The clinical data of patients with SLCT confirmed by surgery and pathology who visited our hospital due to abnormal uterine bleeding or postmenopausal vaginal bleeding from January 2018 to December 2021 were collected.Through retrospective analysis of clinical data,sex hormone indicators,imaging findings,tumor markers,surgery and pathology,we screened SLCT patients with elevated testosterone and AFP.The imaging manifestations,tumor indexes,surgical and pathological results and postoperative follow-up of this special types of SLCT were analyzed.Results Among the 5 patients,2 were postmenopausal women,showing abnormal vaginal bleeding after menopause.The other 3 were women of childbearing age,with previous menstrual regularity and no inducement to menstrual disorder.In 2 patients of childbearing age,the laboratory examination showed that testosterone and AFP were elevated.In 2 patients with elevated testosterone and AFP,pelvic color ultrasound showed abnormal echo in the left adnexal area.Pelvic MRI showed mass in the left adnexal area,and adrenal B-ultrasound/CT showed no obvious abnormality.Tumor markers suggested that the tumor markers(CEA,CA125,CA199 and HE4)were normal in the 2 patients except that AFP levels were elevated.One of the two cases was SLCT with moderate differentiation in the ovary.The tumor tissue was divided into lobulated nodules with few tubules.The tumor cells were mainly Leydig type cells,with round cells,abundant cytoplasm,eosinophilic and granular.Another case is ovarian well differentiated Sertoli-Leydig cell tumor.The tumor cells were arranged in acinar shape and small tubular shape,and mainly Sertoli type cells,with high columnar shape,sparse cytoplasm,light staining and small nuclei.Two patients returned to normal menstrual cycle after operation.One patient s testosterone was 0.5 ng/ml at 2 months after operation,and

关 键 词：卵巢支持-间质细胞瘤 睾酮 甲胎蛋白 临床特征 内分泌特征 

分 类 号：R737.31[医药卫生—肿瘤]