子宫内膜样癌和子宫内膜间质肉瘤组成的卵巢癌肉瘤1例

S. Aishima, S. Fukushima, Y. Nakayama, Katsuyuki Hanashima, Mariko Hashiguchi, M. Yokoyama
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摘要

卵巢癌肉瘤(OCS)是一种罕见的恶性肿瘤,仅占所有卵巢癌的1-4%。44岁绝经前妇女在佐贺大学医院妇产科就诊,主诉为突发性腹痛。血清肿瘤标志物为癌抗原(CA) 19-9 (103U/mL)和CA 125 (114U/mL)。经阴道超声检查显示左腹部有一个复杂的肿块(74×71×67mm),有实性和囊性成分。腹部骨盆计算机断层扫描显示左侧附件区一长直径94 mm的多囊性肿块。患者在检查后立即行剖腹手术,包括全腹子宫切除术、双侧输卵管卵巢切除术和部分网膜切除术。因急诊手术,未行卵巢肿瘤术中组织学诊断。术前影像学检查未见淋巴结肿大,故省略淋巴结切除术。左侧卵巢肿瘤已经出现部分破裂。术后病理检查显示上皮成分呈管状和实体生长,梭形间充质细胞呈束状生长。免疫组织化学鉴定上皮成分为子宫内膜样癌(EC),间质成分为子宫内膜间质肉瘤(ESS)。子宫内膜异位症组织附着于恶性肿瘤。术后患者成功接受辅助化疗(紫杉醇加卡铂)。术后9个月患者仍存活,无复发。考虑到OCS合并EC和ESS的罕见性,我们提出了文献综述,并讨论了几个组织学和临床问题。这类肿瘤的病因和发病机制有待进一步研究。228)。
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A case of ovarian carcinosarcoma composed of endometrioid carcinoma and endometrial stromal sarcoma
Ovarian carcinosarcoma (OCS) is a rare malignancy accounting for only 1‒4% of all ovarian cancers. A 44-year-old premenopausal woman presented at the Obstetrics and Gynecology Department of the University Hospital of Saga, with the chief complaint of sudden abdominal pain. Tumor markers present in her serum were cancer antigen (CA) 19-9 (103U/mL), and CA 125 (114U/mL). Transvaginal ultrasound examination showed a complex mass (74×71×67mm) with solid and cystic components in the left abdominal area. Abdominopelvic computed tomography images showed a polycystic mass with a long diameter of 94 mm in the left adnexal area. The patient underwent a laparotomy immediately after the appropriate evaluation of examinations, leading to total abdominal hysterectomy, bilateral salpingo-oophorectomy and partial omentectomy. Due to the emergency surgery, intraoperative histological diagnosis for ovarian tumor was not performed. The preoperative evaluation of radiological imaging revealed no evidence of lymph node swelling, therefore lymph node resection was omitted. The left ovarian tumor already showed a partial rupture. Pathological examination following surgery revealed tubular and solid growth of the epithelial component and fascicular growth of spindle-shaped mesenchymal cells. Immunohistochemistry identified the epithelial component as endometrioid carcinoma (EC) and the mesenchymal component as endometrial stromal sarcoma (ESS). Endometriotic tissue was attached to the malignant tumor. The patient was successfully treated with adjuvant chemotherapy (paclitaxel plus carboplatin) after surgery. The patient is still alive without recurrence at 9 months after surgery. Considering the rarity of OCS with EC and ESS, we present an overview of the literature and discuss several histological and clinical issues. The etiology and pathogenesis of such tumors require further investigation (words; 228).
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