CAJ | 학술논문

目的：探讨22例卵巢成熟性畸胎瘤恶变的临床病理学特征。方法回顾性分析1826例卵巢成熟性畸胎瘤,对其中22例伴有体细胞恶变的病例进行临床病理学特征分析并行免疫组化染色。结果22例成熟性畸胎瘤恶变占同期1826例卵巢畸胎瘤的1．2%。患者年龄31~79岁,平均56．5岁。临床主要表现为盆腔包块,其中恶变位于左侧卵巢13例,右侧8例,双侧同时累及1例。畸胎瘤大体呈囊性19例,囊实性3例,其中双侧发生的1例左侧为实性、右侧为囊性。畸胎瘤最大径5．0~30．0 cm,平均12．4 cm；恶变成分最大径1．0~10．0 cm,平均3．7 cm。恶变成分为中~低分化鳞状细胞癌14例、类癌4例、腺癌2例、甲状腺乳头状癌2例、肉瘤样癌1例。临床分期：ⅠA期16例,ⅠB期1例,ⅡA期1例,ⅡB期4例。随访6例复发,2例死亡,其余截止随访时均存活。结论卵巢成熟性畸胎瘤中伴有体细胞恶变的发生率低,多见于绝经后女性并表现为盆腔包块,恶变成分组织学上以鳞状细胞癌多见,Ⅰ期患者预后较好。临床与病理医师应重视成熟性畸胎瘤的全面检查及诊断,以防漏诊其中的恶变成分。
목적：탐토22례란소성숙성기태류악변적림상병이학특정。방법회고성분석1826례란소성숙성기태류,대기중22례반유체세포악변적병례진행림상병이학특정분석병행면역조화염색。결과22례성숙성기태류악변점동기1826례란소기태류적1．2%。환자년령31~79세,평균56．5세。림상주요표현위분강포괴,기중악변위우좌측란소13례,우측8례,쌍측동시루급1례。기태류대체정낭성19례,낭실성3례,기중쌍측발생적1례좌측위실성、우측위낭성。기태류최대경5．0~30．0 cm,평균12．4 cm；악변성분최대경1．0~10．0 cm,평균3．7 cm。악변성분위중~저분화린상세포암14례、유암4례、선암2례、갑상선유두상암2례、육류양암1례。림상분기：ⅠA기16례,ⅠB기1례,ⅡA기1례,ⅡB기4례。수방6례복발,2례사망,기여절지수방시균존활。결론란소성숙성기태류중반유체세포악변적발생솔저,다견우절경후녀성병표현위분강포괴,악변성분조직학상이린상세포암다견,Ⅰ기환자예후교호。림상여병리의사응중시성숙성기태류적전면검사급진단,이방루진기중적악변성분。
Purpose To study the clinicopathological characteristics in 22 cases of ovarian mature teratoma with malignant transforma-tion. Methods Clinical and pathologic features were collected and analyzed in 22 out of 1 826 cases of ovarian mature teratoma by retrospective studies, together with immunohistochemical staining. Results In our study, 22 cases (1. 2%) of ovarian mature terato-ma with malignant transformation were identified. The median age was 56. 5 (range, 31~79) years. The main clinical manifestations were pelvic masses, including 13 cases in the left ovary, 8 cases in the right, 1 case was bilateral. Gross cystic teratoma were saw in 19 cases, 3 cases of cystic and solid, the bilateral one was solid in the left which the right was cystic. The teratomas size were 5. 0~30 cm with average 12. 4 cm in diameter. The malignant components’ maximum diameter was about 1. 0~10. 0 cm with average 3. 7 cm. Microscopicically, there were poorly differentiated squamous cell carcinoma in 14 cases, carcinoid carcinoma in 4 cases, adeno-carcinoma in 2 cases, papillary thyroid carcinoma in 2 cases, and the last one was sarcomatoid carcinoma. The FIGO stage distribution was as follows:16 were stage IA, 1 was stage IB, 1 was stage IIA, 4 were stage IIB. Follow up showed 6 cases recurrened, 2 patients died, the rest are survival. Conclusions A low incidence of ovarian mature teratoma in somatic cells with malignant transformation, which are common in postmenopausal women and present with pelvic mass. The main malignant components is squamous cell carcino-ma, patients of stage I have better prognosis. Both clinic and pathology should take more attention to the comprehensive examination and diagnosis of teratoma for prevent misdiagnosis.