PET/CT在儿童及青少年肿瘤患者中的应用

目的评价PET／CT在年轻肿瘤患者中的应用价值。方法回顾性分析我院行躯干PET／CT检查且年龄≤25岁的病例,共75例（男性35例,女性40例）89次检查。结果所患肿瘤前三位依次为淋巴瘤（31％）、卵巢肿瘤（16％）和神经内分泌肿瘤（8％）。PET／CT用于协助诊断（42％）、分期（11％）、疗效评估（27％）和复发监测（30％）。PET／CT对63％（22／35）的淋巴瘤诊断、分期、治疗评估和复发监测有重要意义,改变了58％（7／12）的卵巢肿瘤患者的诊疗决策,对40％的其他肿瘤患者有帮助。对年轻患者的图像分析须注意胸腺、卵巢和子宫内膜等生理性摄取。结论PET／CT对于指导儿童和青少年肿瘤诊疗具有较大价值,可在权衡辐照危害后合理选用。     

卵巢子宫内膜样腺癌PET/CT影像表现

目的:分析卵巢子宫内膜样腺癌（ovarian endometrioid carcinoma,OEC）的PET/CT影像表现,探讨PET/CT在诊断OEC中的价值。方法:回顾性分析颈手术病例证实的27例OEC患者的PET/CT影像特征,包括位置、大小、密度等解剖学特点及18F-FDG代谢水平特征,两组或多组病灶SUVmax值有无差异采用t检验或单因素方差分析。结果:27例患者中有7例同时合并子宫内膜癌;17例为单侧发生（其中左侧7例,右侧10例）,10为双侧发生,共有病灶37个;肿瘤最大径1.5~24 cm,平均（10.92±5.73） cm。31个为囊实性肿物,6个为实性肿物,实性部分均表现为不同程度18F-FDG高摄取,平均SUVmax值为14.30±5.83（5.93~28.33）。肿瘤临床分期,分化程度,雌激素受体（estrogen receptor,ER）、孕激素受体（progesterone receptor,PR）表达量及合并子宫内膜癌与否之间的SUVmax差异均无统计学意义（P均＞0.05）。结论:OEC在PET/CT上多为单侧或双侧明显高代谢的较大囊实性肿块,可伴有腹盆腔种植转移和淋巴结转移,与其他卵巢恶性肿瘤鉴别较困难。如果患者同时合并子宫内膜癌,可对诊断有一定的提示作用。PET/CT全身显像有助于OEC的分期。     

bcl-2、p53蛋白表达在卵巢子宫内膜异位症癌变过程中的作用

目的 探讨p53、bcl-2蛋白表达在卵巢子宫内膜异位症（内异症）癌变过程中的作用。方法 采用免疫组化法检测卵巢子宫内膜异位症组（内异症组,22例）、卵巢异位子宫内膜腺上皮不典型增生组（不典型增生组,14例）、卵巢子宫内膜异位症癌变组（癌变组,22例）的p53、bcl-2蛋白表达。结果 癌变组bcl-2蛋白表达阳性率显著高于内异组（P＜0．05）,不典型增生组bcl-2 蛋白表达阳性率显著高于内异组（P＜0．01）;癌变组p53蛋白表达阳性率显著高于不典型增生组（P＜0．01）及内异组（P＜0．01）,癌变组癌变区p53蛋白表达阳性率显著高于内异区（P＜0．05）;癌变组内异区bcl-2蛋白表达阳性率显著高于内异组（P＜0．05）,不典型增生组内异区bcl-2蛋白表达阳性率显著高于内异组（P＜0．01）。bcl-2、p53蛋白表达与绝经与否、肿瘤期别、生存期无明显相关性（P＞0．05）;癌变组癌变区p53、bcl-2蛋白表达无明显相关性（P＞0．05）。结论 p53、bcl-2的过度表达可能参与了内异症癌变的过程,p53蛋白阳性或bcl-2蛋白阳性的内异症可能是癌前病变。     

17例恶性肿瘤18氟脱氧葡萄糖PET显像假阴性的分析

目的 探讨恶性肿瘤^18氟脱氧葡萄糖（^18F—FDG）PET假阴性患者的FDG摄取特点、影响因素,分析PET／CT检查中CT对其的辅助诊断价值。方法 收集行PET／CT检查者中,^18F-FDGPET为阴性的17例恶性肿瘤患者,对其PET图像进行视觉观察和半定量分析,并与CT及病理检查结果进行对比分析。结果 6例肝癌患者病理证实为高分化型肝细胞肝癌,其中1例有两处病灶,一处病灶FDG摄取、平扫CT密度较周围正常肝组织低下,另一处病灶FDG摄取、平扫CT均为阴性;后行增强CT显示在动脉期两处病灶均明显强化。1例胃印戒细胞癌伴右侧附件转移患者,1例腹壁、大网膜转移性腺癌患者,3例肾透明细胞癌患者和1例前列腺癌患者（高分化型）的^18F—FDGPET诊断受消化道正常生理性FDG摄取或泌尿系统FDG滞留的影响。3例转移癌病变直径≤1cm,其中2例的原发病灶FDG摄取明显增高,1例原发病灶^18F—FDGPET及CT诊断为阴性。68．8％原发肿瘤、66．7％转移肿瘤在平扫CT上显示异常密度,并精确定位;而31．2％原发肿瘤、33．3％转移肿瘤病变^18 F—FDGPET及CT诊断均为阴性。结论恶性肿瘤^18F—FDGPET假阴性与病理学类型、分化程度及病灶大小有关;结合CT或重视PET显像方法可减少恶性肿瘤^18F—FDGPET假阴性。     

子宫内膜与卵巢双原发癌临床病理分析

目的 探讨子宫内膜与卵巢双原发癌的临床病理特点、治疗和预后。方法 回顾性分析12例子宫内膜与卵巢双原发癌,其中两个部位均为子宫内膜腺癌者8例,两个部位是两种完全不同的病理类型者4例。结果 子宫内膜与卵巢双原发癌术前诊断困难,12例均经术后病理确诊。其特点为：卵巢肿瘤体积较小,平均7cm;原发不孕比例高（40．7％）;早期居多,两部位均为I期者8例（66．7％）;病理类型以子宫内膜样癌最多见（66．7％）。所有病例均行手术和化疗,3年生存率为66．7％（8／12）。结论 子宫内膜与卵巢双原发癌是有别于原发性子宫内膜癌或卵巢癌的一种特殊类型的肿瘤,一般发现早,预后较好。     

年轻女性I期子宫内膜腺癌保留卵巢的临床研究

目的:探讨I期子宫内膜腺癌年轻患者卵巢保留与否对患者预后的影响，分析年轻早期子宫内膜腺癌患者保留卵巢的可行性。方法:回顾性分析我院经病理学检验确诊的105例年龄≤40岁的子宫内膜腺癌患者的卵巢转移发生率，同时对所有患者进行6至11年的随访判断患者的生活质量及心血管疾病和骨质疏松的发病情况。结果:卵巢保留组肿瘤转移的发生率为10.0%（3/30）,卵巢切除组肿瘤转移发生率为2.7%（2/75）,卵巢保留组和卵巢切除组5年无瘤存活率（DFS）分别为76.7%（23/30）、86.7%（65/75）,差异无统计学意义；卵巢保留组相对于卵巢切除组其生活质量明显提高,其中卵巢保留组总生活质量评分为(85.82±7.40)，卵巢切除组为 (56.34±7.45)；心血管疾病和骨质疏松的发病率分别为卵巢保留组3.3%（1/30）和0.0%(0/30)，卵巢切除组为12.0%（9/75）和4.0%（3/75），均无显著性差异,但卵巢保留组相对于卵巢切除组患心血管疾病和骨质疏松症的风险也大大降低。结论:对于年轻的I期子宫内膜腺癌患者，保留卵巢可极大地提高其生活质量，减少心血管疾病和骨质疏松的发生，这对年轻子宫内膜癌患者具有重要意义。     

PET/CT评价肺部不同大小单发结节的价值

目的评价^18F-FDG PET／CT对不同大小肺部单发结节的诊断价值。方法回顾性分析〈3cm的肺部单发结节待查具有明确随访结果患者60例，其中恶性病变33例，包括腺癌19例、鳞癌5例、肺泡细胞癌5例、小细胞性肺癌1例、腺鳞癌1例及临床诊断肺癌2例；良性病变27例，包括非特异性炎症、错构瘤、腺瘤、结核及感染性肉芽肿。根据结节大小（以肺窗上结节的最大直径为测量对象）将病变分为3组：（1）≤1cm（14例）；（2）1．1～2．0cm（22例）；（3）2．1～3.0cm（24例）。由有经验的核医学医师和放射科医师共同读片。PET／CT诊断恶性肺结节标准为：（1）肺结节的SUV≥2.5；（2）延迟显像SUV值升高≥20％～30％并参考CT征象，如有毛刺、分叶、血管集束征等综合分析诊断恶性，对SUV值变化不明显者尤其要注意CT征象；（3）根据CT图像对结节进行定位，综合上述标准的诊断结果为最终的PET／CT诊断结果。除两例临床诊断肺癌行了刀治疗外的所有恶性肺部结节均得到组织病理学证实（包括手术后病理、活检病理及细胞学检查）。组织病理学证实良性或随访中病灶消失或随访1年未见生长的结节诊断为良性病变。结果60例患者中，PET／CT诊断正确55例，准确性为91．7％，灵敏度和特异性分别为93．9％、88．9％。PET／CT假阴性2例，均为细支气管肺泡细胞癌，病灶大小分别为4mm和24mm，前者PET上未见放射性摄取，后者轻度放射性摄取，SUV最大值为1．4，PET／CT假阳性3例，2例为结核病灶（0．9cm、1．6cm），1例为肉芽肿（2．2cm），SUV最大值分别为3．9、6．7、5．4。结论PET／CT是评价肺内单发结节的一种有效的非创伤性检查方法，诊断准确性较好。对1cm以下的结节诊断灵敏度相对较低，PET空间分辨率偏低及肿瘤的细胞类型、分化程度是其主要原因。     

子宫内膜癌合并卵巢恶性肿瘤

１７例同时发生子宫内膜及卵巢恶性肿瘤的病例，根据肿瘤的组织学类型分为二组：Ａ组：７例患者子宫和卵巢均为子宫内膜样腺癌；Ｂ组；１０例为子宫内膜腺癌合并卵巢其他类型的恶性肿瘤（如浆液性乳头状腺癌、粘液腺癌、中胚叶混合瘤等），Ａ、Ｂ二组的生存率无显著性差别（分别为７１％、５０％，平均随诊２２个月），然而，深肌层受侵者预后较差。     

卵巢良性肿瘤经阴道手术术式探讨简

目的：探讨卵巢良性肿瘤经阴道手术的可行性和安全性。方法：回顾性分析74例经阴道手术的卵巢良性肿瘤患者的临床资料，患者的一般情况、手术方式、方法、术中及术后情况。结果：年龄22—69岁，平均年龄40岁，阴道分娩史占70．27％（52／74），剖宫产史占8．11％（6／74），其中2例有2次剖宫产史。无产史占21．62％（16／74），其中流产史4例，无孕史占16．22％（12／74），有妇科盆腔手术史占8．11％（6／74）。74例患者无中转开腹。手术时间20—65分钟，平均30分钟。术中出血20—60毫升，平均30毫升。术后排气时间6—24小时，平均10小时。术后无发热，住院天数2—6日，阴道伤口愈合良好。术后病理诊断：畸胎瘤占40．54％（30／74），子宫内膜异位囊肿占25．68％（19／74），黄体囊肿及滤泡囊肿等生理性囊肿占12．16％（9／74），浆液性囊腺瘤占10．81％（8／74），黏液性囊腺瘤占6．76％（5／74），卵巢纤维瘤及泡膜纤维瘤占4．05％（3／74）。结论：术者应具有娴熟的手术技巧和丰富经验，严格把握适应证，卵巢良性肿瘤经阴道手术是安全可行的。     

154例子宫和卵巢切除病例临床病理分析

目的 探讨子宫和卵巢切除手术的指征，指导临床治疗，减少对子宫卵巢不必要的损伤，维持卵巢的内分泌功能。方法 对来自五家医院病理科的154例子宫全切或次全切，同时有卵巢切除标本病理切片和临床资料进行回顾性分析。结果 154例标本中卵巢良性肿瘤14例（9．09％），瘤样病变106例（68．83％），卵巢未见明显病变31例（20．13％），恶性肿瘤3例（1．95％）；子宫平滑肌瘤105例（68．2％），子宫腺肌症30例（19．5％）；内膜增殖症12例（7．8％）。结论 年轻患者（〈35岁）应采用微创手术，术中尽量保留子宫卵巢正常的解剖关系，维护其生理功能。     

妇科肿瘤患者尿液中血管抑素水平及临床意义

[目的]探讨测定尿液中血管抑素在妇科肿瘤诊断方面的价值.[方法]赖氨酸-ELISA法测定25例健康妇女、31例妇科良性肿瘤患者及32例妇科恶性肿瘤患者尿液中血管抑素水平.[结果]妇科恶性肿瘤组尿血管抑素水平及阳性率(中位水平为2.06,阳性率78%)高于正常组及良性肿瘤组(中位水平分别为0.70及0.80,阳性率分别为32%及35%),差异有显著性(P＜0.05及P＜0.01);正常组与良性肿瘤组尿血管抑素水平差异无显著性(P＞0.05).[结论]赖氨酸-ELISA法测定尿液中血管抑素水平可能成为一项协助妇科恶性肿瘤临床诊断的指标.     

PET/CT显像在妇科恶性肿瘤术后复发及转移中的临床应用价值

目的:探讨正电子发射断层显像(PET/CT)在诊断妇科恶性肿瘤术后复发与转移中的临床应用价值。方法:回顾性分析2015年1月至2016年12月,在我中心行PET/CT检查的56例妇科恶性肿瘤术后患者的全身PET/CT的显像结果,确诊依据为术后病理结果、血糖类抗原125（CA125）持续升高水平和临床随诊结果,评价PET/CT对妇科恶性肿瘤术后复发、转移的诊断效能。结果:56例患者中,经病理结果、血CA125持续升高水平、临床随诊结果证实,肿瘤复发及转移者25例,没有复发、转移者26例,假阳性者3例,假阴性者2例,PET/CT显像在妇科恶性肿瘤术后复发及转移的灵敏度、特异性、准确率分别为92.6%（25/27）、89.7%（26/29）、91.1%（51/56）;转移灶分为阴道残端、全身淋巴结、远处器官转移,PET/CT显像对各转移灶的灵敏度及特异性分别为87.5%(7/8)和97.9%(47/48)、95.0%（19/20）和91.7%（33/36）、91.3%（21/23）和90.9%（30/33）;PET/CT显像发现全身多部位、多器官转移的6人,改变了临床分期及治疗方案。结论:PET/CT显像对妇科恶性肿瘤术后复发及转移的诊断,具有较高的灵敏度和特异性,对肿瘤术后复发及转移的临床分期及治疗方案的确定具有非常大的指导意义。     

CA125和TSGF联合检测在妇科肿瘤诊断中的应用价值

目的 探讨联合检测血清CA125和肿瘤相关物质群（TSGF）的含量对妇科恶性肿瘤的诊断及疗效监测的应用价值。方法 妇科恶性肿瘤患者223例、妇科良性肿瘤患者90例及正常对照98人的血清样品，分别用电化学发光免疫测定法和化学比色定量法测定CA125和TSGF含量，然后进行分析。结果 与良性肿瘤组和健康体检组相比，妇科恶性肿瘤患者血清CA125和TSGF的含量明显升高（P〈0.01），CA125和TSGF测定对妇科恶性肿瘤的敏感度分别是58.3%和72.2% ，特异度分别是91.0%和90.4%。二者联合检测的敏感度和特异度分别为79.4%和82.4%。妇科恶性肿瘤患者血清CA125和TSGF含量在治疗后与治疗前相比,有显著差异（P〈0.05）。 结论 血清CA125和TSGF检测对妇科肿瘤良恶性的辅助诊断及鉴别诊断具有一定应用价值，联合检测不仅可以提高妇科恶性肿瘤的阳性诊断率，对妇科恶性肿瘤的疗效观察和术后监测也具有一定价值。     

Correlation between angiographically assessed vascularity and blood flow in hepatic metastases in patients with colorectal carcinoma

BACKGROUND: The correlation between vascularity and blood flow in hepatic metastases in patients with colorectal carcinoma was studied in 22 metastatic liver tumors. METHODS: Hepatic metastases were categorized into Grades A-C, in order of increasing vascularity, as determined by hepatic angiography. Of the 22 metastatic liver tumors from 15 patients that showed on angiography, 5 tumors had slightly increased tumor vascularization (Grade A), 10 tumors had vascularization similar to normal (Grade B), and 7 tumors showed decreased vascularization relative to liver parenchyma (Grade C). Blood flow in these metastatic liver tumors was calculated quantitatively by positron emission tomography (PET) scanning using the C(15)O(2) steady-state method and the H(2)(15)O dynamic method. RESULTS: Using the H(2)(15)O method, blood flow value in Grade A tumors was 52.9 +/- 17.0 mL per 100 g per minute (mean +/- standard error), that in Grade B tumors was 35.7 +/- 3.8 mL per 100 g per minute, and that in Grade C tumors was 31.7 +/- 6.6 mL per 100 g per minute. CONCLUSIONS: A significant difference was found between blood flows in Grade A metastatic liver tumors and Grade B or C tumors (P < 0.002). There was no significant difference between blood flows in Grade B and C tumors. PET scan quantification results were almost parallel with the angiographic results. Even Grade C tumors had sufficient blood flow, about 32 mL per 100 g per minute on dynamic PET scans. These findings suggest that blood flow in hepatic metastases from colorectal carcinoma is greater than generally is believed.     

The impact of 18F-deoxyglucose positron emission tomography on tumor staging, treatment strategy and treatment planning for radiotherapy in a department of radiation oncology

AIMS AND BACKGROUND: The study analyzed the potential contribution of positron emission tomography (PET) in patient selection for radiotherapy and in radiation therapy planning. METHODS: Eighty-seven patients with a histological cancer diagnosis were accrued for the study from December 2000 to December 2001. Demographic characteristics included a median age of 54 years and male/female ratio of 51/36. All patients staged by conventional workup who were candidates for radiotherapy had PET imaging and were allocated to a conventional "pre/post-PET stage". The treatment protocol and the shape and/or size of the portals was directly related to PET results. We examined 26 lung cancers, 15 gastrointestinal tumors, 22 genitourinary cancers and 24 hematologic malignancies. RESULTS: In the lung cancer group, the stage was modified in 10/26 patients (38.5%) by PET, with a change in management in 13 (50%) and a change in radiotherapy planning in 6 (23.1%). In the hematological group, stage was modified by PET in 8/24 cases (33.3%), with a change in treatment strategy in 9 (37.5%) and a change in radiotherapy planning in 3 (12.5%). In the gastrointestinal group, the stage was modified by PET in 2/15 cases (13.4%), with a change inn treatment strategy in 4 (26.7%) and a change in the decision for radiotherapy in 8 (no radiotherapy in 53.3%). In the mixed group (genitourinary, breast and other), the stage was modified by PET in 6/22 cases (27.3%), with a change in treatment strategy in 11 (50%) and a very low rate of change in radiotherapy planning. CONCLUSIONS: PET contributed to a modification of stage in 26/87 patients (30%), to a changing in treatment strategy in 37/87 (42.5%), and to a substantial change of the shape and/or size of radiotherapy portals in 13/43 (30%) who underwent radiotherapy.     

Primary carcinoma of the female urethra: single center experience of 18 cases

BACKGROUND: Primary carcinoma of the urethra is more common in women than in men. Vague symptoms in the early stages delay the diagnosis in most patients. Surgery and radiotherapy are used as treatment modalities for these tumors, either alone or in combination. METHODS: We retrospectively analyzed the records of 18 female patients with urethral cancer presented to our institution. Secondary tumors involving the urethra from adjacent organs like bladder carcinoma and gynecological cancer were excluded. RESULTS: In our review, the overall survival was 74% at 3 years and 33% at 5 years with median overall survival of 51 months. There was a statistically better overall survival in patients with early stage tumors compared with later stage disease (P = 0.03) and patients with distally located tumors had better survival compared with proximal and whole urethral involvement. CONCLUSIONS: The prognosis is poor in advanced stages and in those with proximal or whole urethral involvement, requiring extensive surgical procedures. The aim of treatment in distal urethral carcinomas should be local excision and radiotherapy, thereby preserving the bladder.     

The integration of 18-fluoro-deoxy-glucose positron emission tomography and endoscopic ultrasound in the treatment-planning process for esophageal carcinoma

PURPOSE: Accurate delineation of the gross tumor volume (GTV) is important in radiation therapy treatment planning. We evaluated the impact of PET and endoscopic ultrasound (EUS) compared with CT simulation in the planning of radiation fields for patients with esophageal carcinoma. MATERIAL AND METHODS: Twenty-five patients presenting with esophageal carcinoma for radiation therapy underwent PET scans in the treatment position after conventional CT simulation. Patients underwent PET/CT scanning after being injected with 10 to 20 mCi of [F-18]-2-deoxy-2-fluro-D-glucose. The length of the abnormality seen on the CT portion of the PET/CT scan vs. the PET scan alone was determined independently by 2 separate investigators. The length of the GTV and detection of regional adenopathy by PET was also correlated with EUS in 18 patients. Of the 18 patients who had EUS, 2 had T2 tumors and 16 had T3 tumors. Eighteen patients had adenocarcinoma and 7 had squamous cell carcinoma. Nine tumors were located at the gastroesophageal junction, 8 at the lower esophagus, 7 in the middle esophagus, and 1 in the cervical esophagus. The PET scans were reviewed to determine the length of the abnormality by use of a standard uptake value (SUV) of 2.5 to delineate the tumor extent. RESULTS: The mean length of the cancer was 5.4 cm (95% CI 4.4-6.4 cm) as determined by PET scan, 6.77 cm (95% CI, 5.6-7.9 cm) as determined by CT scan, and 5.1 cm (95% CI, 4.0-6.1 cm) for the 22 patients who had endoscopy. The length of the tumors was significantly longer as measured by CT scans compared with PET scans (p = 0.0063). EUS detected significantly more patients with periesophageal and celiac lymphadenopathy compared to PET and CT. The SUV of the esophageal tumors was higher in patients with peri-esophageal lymphadenopathy identified on PET scans. CONCLUSION: Endoscopic ultrasound and PET scans can add additional information to aid the radiation oncologist's ability to precisely identify the GTV in patients with esophageal carcinoma.     

Increased fluorine-18 2-fluoro-2-deoxy-D-glucose (FDG) uptake in childhood CNS tumors is correlated with malignancy grade: a study with FDG positron emission tomography/magnetic resonance imaging coregistration and image fusion.

PURPOSE Positron emission tomography (PET) has been used in grading of CNS tumors in adults, whereas studies of children have been limited. PATIENTS AND METHODS Nineteen boys and 19 girls (median age, 8 years) with primary CNS tumors were studied prospectively by fluorine-18 2-fluoro-2-deoxy-D-glucose (FDG) PET with (n = 16) or without (n = 22) H(2)(15)O-PET before therapy. Image processing included coregistration to magnetic resonance imaging (MRI) in all patients. The FDG uptake in tumors was semiquantitatively calculated by a region-of-interest-based tumor hotspot/brain index. Eight tumors without histologic confirmation were classified as WHO grade 1 based on location, MRI, and clinical course (22 to 42 months). Results Four grade 4 tumors had a mean index of 4.27 +/- 0.5, four grade 3 tumors had a mean index of 2.47 +/- 1.07, 10 grade 2 tumors had a mean index of 1.34 +/- 0.73, and eight of 12 grade 1 tumors had a mean index of -0.31 +/- 0.59. Eight patients with no histologic confirmation had a mean index of 1.04. For these 34 tumors, FDG uptake was positively correlated with malignancy grading (n = 34; r = 0.72; P < .01), as for the 26 histologically classified tumors (n = 26; r = 0.89; P < .01). The choroid plexus papilloma (n = 1) and the pilocytic astrocytomas (n = 3) had a mean index of 3.26 (n = 38; r = 0.57; P < .01). H(2)(15)O-uptake showed no correlation with malignancy. Digitally performed PET/MRI coregistration increased information on tumor characterization in 90% of cases. CONCLUSION FDG PET of the brain with MRI coregistration can be used to obtain a more specific diagnosis with respect to malignancy grading. Improved PET/MRI imaging of the benign hypermetabolic tumors is needed to optimize clinical use.     

Differential tumor microenvironment in human ovarian cystic tumors

AIMS AND BACKGROUND: Cells and soluble mediators obtained from tumor effusions are useful in evaluating the tumor microenvironment. Our aim was to examine cytologically and to quantify the leukocyte infiltrate, nitric oxide, cytokines and tumor markers in the intracystic fluid from patients with a cystic adnexal mass, for a possible differentiation between benign and malignant findings. METHODS AND STUDY DESIGN: Sixty-six women who had their cystic fluids collected were prospectively divided into benign tumor (22, 33.3%), malignant tumor (10, 15.2%) or other gynecological alterations (34, 51.5%). Cytology, total and differential leukocyte counts were determined by light microscopy. Tumor markers, cytokines and nitric oxide were assayed in the supernatants using the Immulite system, ELISA and Griess reaction, respectively. RESULTS: The sensitivity and specificity of the cytological analysis was 66.7% and 97.7%, respectively. The levels of CA 19.9, CA 15.3, alpha-fetoprotein, carcinoembryonic antigen, progesterone and beta-HCG were significantly higher in the benign and/or malignant group than in the other gynecological alterations. Also, the local concentrations of CA 15.3 and beta-HCG were significantly higher in malignant than in benign tumors. In malignant tumors, increased leukocyte counts and higher concentrations of IL-6, IL-10 and nitric oxide were detected than in benign tumors or other gynecological alterations. CONCLUSIONS: In malignant tumors, the microenvironment could be differentiated from benign tumors or other gynecological alterations by cystic fluid analysis.