以腹水为首发症状的卵巢幼年型颗粒细胞瘤1例及文献复习
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摘要
目的通过分析以腹水为首发症状的卵巢幼年型颗粒细胞瘤(JGCT)患者的临床资料,并查阅相关文献资料,为临床诊断提供参考依据。方法系统回顾1例以腹水为首发症状的JGCT患者的临床表现、腹水性质、影像学及腹腔镜下卵巢肿瘤病变特征、治疗方法及预后,并结合相关文献复习讨论。结果患者女,19岁,表现为进行性腹胀加重伴有纳差不适,门诊B超提示腹盆腔大量积液,入院腹穿提示渗出液,淋巴细胞升高为主,腹水肿瘤及血清CA125显著升高,雌二醇轻度升高,腹部CT示左侧附件区畸胎瘤,右侧附件区囊实性变?行腹腔镜探查及术后病理免疫组化示左侧(卵巢)囊性成熟性畸胎瘤,右侧卵巢幼年型颗粒细胞瘤,分期为IC期,术后给予TP方案化疗,随访6个月至今,无复发。结论对以不明原因腹水为首发症状的年轻女性,需高度警惕JGCT可能,应常规进行妇科、盆腔超声或影像学及腹腔镜检查,以及时诊断及治疗。
Objective To analyze the clinical data of patients with ovarian juvenile granulosa cell tumor(JGCT) with ascites as the first symptom, and to review the relevant literatures, and to provide reference for clinical diagnosis. Methods The clinical manifestations, ascites properties, imaging and laparoscopic ovarian tumor features, treatment methods and prognosis of ovarian JGCT patients with ascites as the first symptom were retrospectively analyzed and discussed with the literature review. Results A 19-year old girl showed an increase in progressive abdominal distension accompanied by anorexia discomfort and outpatient B ultrasound prompted a large number of pelvic pelvic fluid. The ascites nature of the patient was the effusion of lymphocyte elevation. Ascites tumor and serum CA125 Significantly increased.Abdominal CT showed left attachment area teratoma, right attachment area capsule solid change? Laparoscopic exploration confirmed that the patient's right ovarian pathology immunohistochemistry was juvenile granulosa cell tumor, stage for the IC period. Patients underwent TP regimen chemotherapy, followed up for 6 months to date without recurrence. Conclusion Taken together, we should be highly vigilant the juvenile granulosa cell tumor with massive ascites as the first clinical manifestation.
Objective To analyze the clinical data of patients with ovarian juvenile granulosa cell tumor(JGCT) with ascites as the first symptom, and to review the relevant literatures, and to provide reference for clinical diagnosis. Methods The clinical manifestations, ascites properties, imaging and laparoscopic ovarian tumor features, treatment methods and prognosis of ovarian JGCT patients with ascites as the first symptom were retrospectively analyzed and discussed with the literature review. Results A 19-year old girl showed an increase in progressive abdominal distension accompanied by anorexia discomfort and outpatient B ultrasound prompted a large number of pelvic pelvic fluid. The ascites nature of the patient was the effusion of lymphocyte elevation. Ascites tumor and serum CA125 Significantly increased.Abdominal CT showed left attachment area teratoma, right attachment area capsule solid change? Laparoscopic exploration confirmed that the patient's right ovarian pathology immunohistochemistry was juvenile granulosa cell tumor, stage for the IC period. Patients underwent TP regimen chemotherapy, followed up for 6 months to date without recurrence. Conclusion Taken together, we should be highly vigilant the juvenile granulosa cell tumor with massive ascites as the first clinical manifestation.
引文
[1]张江宇,张宴,陈文静,等.卵巢幼年型颗粒细胞瘤一例[J].中华临床医师杂志,2012,6(2):452-454.
[2]苏少慧,苏怡霞,杨冬野.肝硬化腹水脐疝破裂2例[J].罕少疾病杂志,2006,13(4):52-53.
[3]张权武.醋酸泼尼松片在结核性多浆膜腔积液患者中的临床疗效及安全性研究[J].罕少疾病杂志,2016,23(6):19-20.
[4]Wilberger A,Yang B.Gynandroblastoma With Juvenile Granulosa Cell Tumor and Concurrent Renal Cell Carcinoma:A Case Report and Review of Literature[J].Int J Surg Pathol,2015,5(23):393-8.
[5]Bedir R,Mürtezaoglu AR,Calapoglu AS,et al.Advanced stage ovarian juvenile granuloza cell tumor causing acute abdomen:a case report[J].Arch Iran Med,2014,9(17):645-648.
[6]Ashnagar A,Alavi S,Nilipour Y,et al.Massive ascites as the only sign of ovarian juvenile granulosa cell tumor in an adolescent:a case report and a review of the literature[J].Case Rep Oncol Med,2013,2013:386725.
[7]Kaur H,Bagga R,Saha SC,et al.Juvenile granulosa cell tumor of the ovary presenting with pleural effusion and ascites[J].Int JClin Oncol,2009,14(01):78-81.
[8]Imai A,Furui T,Shimokawa K,et al.Juvenile granulosa cell tumor in a 2-year-old infant:report of a case complicated with ascites and acute respiratory distress[J].Gynecol Oncol,1992,3(46):397-400.
[9]彭萍,沈铿,郎景和,等.卵巢幼年型颗粒细胞瘤四例临床分析[J].中华妇产科杂志,2002,7(37):402-404.
[10]Benesch M,Lackner H,Pilhatsch A,et al.Long-term Remission in a Female With Multiple Relapsed Juvenile Granulosa Cell Tumor[J].J Pediatr Hematol Oncol,2015,8(37):486-489.
[11]Grabiec M,Kwiatkowski M,Walentowicz M,et al.Current views on treatment of the ovarian granulosa-cell tumor[J].Ginekol Pol,2008,1(79):42-46.
[12]Majdoul S,Tawfiq N,Bourhaleb Z,et al.Recurrence occurring ten years after the initial diagnosis of granulosa cell tumour of the ovary:about two cases and review of the literature[J].Pan Afr Med J,2016,25:30.
[2]苏少慧,苏怡霞,杨冬野.肝硬化腹水脐疝破裂2例[J].罕少疾病杂志,2006,13(4):52-53.
[3]张权武.醋酸泼尼松片在结核性多浆膜腔积液患者中的临床疗效及安全性研究[J].罕少疾病杂志,2016,23(6):19-20.
[4]Wilberger A,Yang B.Gynandroblastoma With Juvenile Granulosa Cell Tumor and Concurrent Renal Cell Carcinoma:A Case Report and Review of Literature[J].Int J Surg Pathol,2015,5(23):393-8.
[5]Bedir R,Mürtezaoglu AR,Calapoglu AS,et al.Advanced stage ovarian juvenile granuloza cell tumor causing acute abdomen:a case report[J].Arch Iran Med,2014,9(17):645-648.
[6]Ashnagar A,Alavi S,Nilipour Y,et al.Massive ascites as the only sign of ovarian juvenile granulosa cell tumor in an adolescent:a case report and a review of the literature[J].Case Rep Oncol Med,2013,2013:386725.
[7]Kaur H,Bagga R,Saha SC,et al.Juvenile granulosa cell tumor of the ovary presenting with pleural effusion and ascites[J].Int JClin Oncol,2009,14(01):78-81.
[8]Imai A,Furui T,Shimokawa K,et al.Juvenile granulosa cell tumor in a 2-year-old infant:report of a case complicated with ascites and acute respiratory distress[J].Gynecol Oncol,1992,3(46):397-400.
[9]彭萍,沈铿,郎景和,等.卵巢幼年型颗粒细胞瘤四例临床分析[J].中华妇产科杂志,2002,7(37):402-404.
[10]Benesch M,Lackner H,Pilhatsch A,et al.Long-term Remission in a Female With Multiple Relapsed Juvenile Granulosa Cell Tumor[J].J Pediatr Hematol Oncol,2015,8(37):486-489.
[11]Grabiec M,Kwiatkowski M,Walentowicz M,et al.Current views on treatment of the ovarian granulosa-cell tumor[J].Ginekol Pol,2008,1(79):42-46.
[12]Majdoul S,Tawfiq N,Bourhaleb Z,et al.Recurrence occurring ten years after the initial diagnosis of granulosa cell tumour of the ovary:about two cases and review of the literature[J].Pan Afr Med J,2016,25:30.