具有内分泌异常表现的儿童卵巢肿瘤临床特点分析  

Clinical analysis of pediatric ovarian tumors with endocrine disorders

作　　者：陈可欣 严向明[1] 张振乾 张婷[1] 付明翠[1] 周云[1] 曹戌[1] Chen Kexin;Yan Xiangming;Zhang Zhengqian;Zhang Ting;Fu Mingcui;Zhou Yun;Cao Xu(Department of Pediatric Urology,Affiliated Children's Hospital,Soochow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属儿童医院泌尿外科,苏州215000

出　　处：《中华小儿外科杂志》2022年第12期1082-1087,共6页Chinese Journal of Pediatric Surgery

基　　金：江苏省自然科学基金项目(BK20191176);苏州市第五批姑苏卫生人才培养项目(GSWS2019052、GSWS2020049);苏州市儿童结构畸形重点实验室(SZS2022018)。

摘　　要：目的探讨具有内分泌功能异常表现的儿童卵巢肿瘤的临床特点及病理特征,为其早期诊断和治疗提供参考依据。方法回顾性分析2015年4月至2021年4月苏州大学附属儿童医院收治的15例具有性早熟、不规则阴道出血、月经异常等内分泌功能异常表现的卵巢肿瘤患儿的临床资料,并进行随访。15例患儿年龄范围为3岁11个月至16岁5个月,中位年龄为10岁1个月。因性早熟就诊发现卵巢肿瘤7例,月经异常8例(经期延长3例,月经不规律3例,停经2例)。共8例术前完善性激素检查,8例雌二醇均升高。15例患儿均行腹腔镜探查,其中2例行患侧附件切除术,余13例行卵巢肿瘤剥除术。结果病理检查提示上皮细胞肿瘤5例,生殖细胞肿瘤4例,性索-间质肿瘤6例;其中3例恶性肿瘤(2例幼年型颗粒细胞瘤,1例未成熟畸胎瘤),2例环状小管性索肿瘤为交界性肿瘤。术后1例未成熟畸胎瘤行化疗,余无特殊治疗。随访14例患儿均无复发,性早熟患儿症状消失,月经紊乱患儿月经恢复正常。结论有内分泌功能异常表现的儿童卵巢肿瘤中恶性肿瘤发生率较高,尤以性索-间质肿瘤多见,术前应予以完善性激素、抗米勒管激素、抑制素、人绒毛膜促性腺激素、肿瘤标志物等检查,术中予以快速冰冻病理评估肿瘤的性质,根据病理结果决定手术方式以及切除范围;并依据术后病理诊断确定后续治疗方案。Objective To explore the clinicopathological characteristics of pediatric ovarian tumors with endocrine disorders and to provide rationales for early interventions.Methods Clinical data were retrospectively reviewed for 15 children with a diagnosis of ovarian tumors with endocrine disorders of precocious puberty(n=7)and irregular menstruation(n=8).The median age was 121(47-197)months.The level of estradiol was elevated(n=8).Results After laparoscopic exploration,adnexectomy(n=2)and ovarian cystectomy(n=13)were performed.Histopathological diagnosis was epithelial ovarian tumors(n=5),germ cell tumors(n=4)and sex cord-stromal tumors(n=6).Three cases were malignant tumors,including juvenile granulosa cell tumor(n=2)and immature teratoma(n=1).Two sex-cord tumors with annular tubules were borderline tumors.One case of immature teratoma received postoperative chemotherapy.During follow-ups,the symptoms of precocious puberty and irregular menstruation disappeared and there was no tumor recurrence.Conclusions There is a high incidence of malignancy in pediatric ovarian tumors with endocrine disorders,especially sex cord-stromal tumors.Therefore preoperative examinations such as sex steroids,anti-Mullerian hormone(AMH),inhibin,human chorionic gonadotropin(HCG)and tumor markers should be performed along with frozensection pathology to evaluate the nature of tumor and determine the resection range.Moreover,follow-up treatments should be guided by a definite pathological diagnosis.

关 键 词：卵巢肿瘤 儿童 内分泌 卵巢性索间质肿瘤 

分 类 号：R737.31[医药卫生—肿瘤]