微乳头型卵巢浆液性交界性肿瘤病例及文献复习

目的探讨微乳头型卵巢浆液性交界性肿瘤患者的临床特点、病理诊断及其治疗。方法对2001-2009年解放军总医院收治的4例微乳头型卵巢浆液性交界性肿瘤患者的临床及病理诊断资料结合文献进行回顾性分析。结果 4例患者均为生育期妇女,年龄29-35岁,其中2例原发不孕。术中发现均双侧卵巢外生型肿瘤,Ⅰ期2例,Ⅲ期2例。1例临床Ⅲ期腹膜非浸润性种植,行保留生育功能手术（同时切除大网膜）,随访5年无复发;1例临床Ⅲ期腹膜浸润性种植,行肿瘤细胞减灭术,随访3年无复发。1例Ⅰ期腹膜非浸润性种植,行保留生育功能手术（未切除大网膜）,1年复发,仍为微乳头型卵巢浆液性交界性肿瘤。1例Ⅰ期腹膜浸润性种植,行保留生育功能手术（未切除大网膜）,2年复发,为低级别浆液性癌。4例均术后辅助化疗。结论微乳头型卵巢浆液性交界性肿瘤发生在双侧卵巢的几率较高,临床分期较高,易发生浸润性卵巢外病变。无论期别早晚,手术均应行全面规范病理分期手术,保守性手术适用于年轻有生育要求的I期患者,对癌变及伴有浸润性种植者应辅助化疗。

Ovarian micropapillary serous borderline tumor: A report of 4 cases and review of the literature

Objective To study the clinical features,pathological diagnosis and treatment of micropapillary serous borderline tumors.Methods Clinical and pathologic data about 4 patients with micro-papillary serous borderline tumor admitted to Chinese PLA General Hospital in 2001-2009 were retrospectively analyzed.Results Of the 4 female patients at the reproductive age of 29-35 years,2 were infertile.Bilateral exogenous ovarian tumor at stage 1 and stage III was found in 2 patients,respectively.Non-invasive peritoneal borderline tumor at stage was observed in 1 patient who underwent conservative surgery and was alive without recurrence during the 60-month follow-up,and peritoneal invasive borderline tumor at stage III was found in 1 patient who received cytoreductive surgery（CRS） and was alive without recurrence during the 36-month follow-up.Case 3 with stage I Non-invasive peritoneal borderline tumor at stage 1 was detected in 1 patient who underwent conservative surgery and recurred 12-month after operation.Peritoneal invasive borderline tumor at stage I was observed in 1 patient who received conservative surgery and progressed to lower-grade serous carcinoma 2 years after operation.The 4 patients received postoperative adjuvant chemotherapy.Conclusion Micro-papillary serous borderline ovarian tumor frequently occurs in bilateral ovaries with a high clinical stage,usually leading extraovarian invasive lesions.Surgery is the most important treatment modality for the tumor at early or late stage.Young patients desiring for pregnancy should undergo conservative surgery for the preservation of fertility and those with late stage cancer with invasion implantation should receive chemotherapy.