卵巢支持莱迪细胞瘤15例临床病理分析

摘要

Objective:To investigate the clinicopathological features, treatment and prognosis of patients with ovarian Sertoli-Leydig cell tumor (SLCT). Methods:From 1962 to 2009, the clinicopathological data of fifteen cases with Sertoli-Leydig cell tumors were retrospectively reviewed in our hospital. Results:All the patients were not initially considered as ovarian Sertoli-Leydig cell tumor. Among them, 13 patients presented endocrine manifestations (including virilization, feminization, and defeminization). Six feminine patients had estrogen related diseases (such as uterine myoma, endometrial carcinoma and endometrial hyperplasia). There was gross ovarian mass in fourteen patients during operation, while one patient was found this disease during postoperative pathological examination. Of all patients, 6 had well differentiated tumors, 5 had moderately differentiated tumors (1 with retiform pattern and heterologous elements), while 4 had poorly differentiated tumors. Two patients with poorly differentiated tumors were misdiagnosed as ovarian epithelial carcinoma or granulosa cell tumor by frozen section. Of 5 patients who underwent fertility-sparing surgery, 3 had given birth to a child. Of 8 patients underwent staging operation, one had omental metastasis. Nine patients with poorly or moderately differentiated tumors received adjuvant chemotherapy. With a follow-up of 2 -34 years, 14 patients were living with free of tumor, while one poorly differentiated patient developed recurrence 4 years later. Conclusions:It is hard to diagnose ovarian Sertoli-Leydig cell tumor in time. Endocrine symptom might provide important clue to Sertoli-Leydig cell tumor before operation. Fertility-sparing surgery could be considered for the patients'favourable outcome. Recurrence in poorly differentiated tumors should be concerned.%目的:探讨卵巢支持莱迪细胞瘤的临床特点、病理特征、治疗及预后.方法:回顾性分析我院1962年至2009年诊治的15例卵巢支持莱迪细胞肿瘤患者的临床和病理资料.结果:15例术前均未考虑本病,其中13例有男性化、女性化及去女性化表现.6例女性化表现患者同时合并雌激素相关疾病(如子宫肌瘤、子宫内膜癌、子宫内膜增生).14例术中见大体肿瘤,1例因子宫内膜癌手术,术后病理检查发现本病.肿瘤高分化6例,中分化5例(含有网状及异型成分1例),低分化4例.2例低分化肿瘤术中冰冻病理检查分别误诊为卵巢癌及卵巢颗粒细胞瘤.5例患者保留生育功能,其中3例实现生育.8例患者接受分期手术,其中1例术中发现肿瘤大网膜转移.15例中,9例中、低分化者术后接受辅助化疗.随诊2 ～ 34年,14例患者无瘤存活,1例低分化肿瘤治疗后4年复发.结论:支持莱迪细胞瘤难以及时诊断,患者的内分泌表现是提示本病的重要线索.预后良好,对于本病患者可行保留生育功能手术,但需注意低分化肿瘤的复发问题.