原发性生殖器恶性黑色素瘤15例临床分析

目的：探讨原发性生殖器恶性黑色素瘤的诊断、治疗特点及影响预后的因素。方法：对我院收治的１５例原发性生殖器恶性黑色素瘤的临床资料进行回顾性分析。结果：发生于外阴、阴道，宫颈的黑色素瘤分别为４例、９例、２例。１１例行手术切除辅以化疗加免疫疗法，４例行化疗和免疫等疗法。１５例中，１例失访，５例生存＜１年，７例＜２年，２例＞３年，其中１例存活１９年。结论：原发性生殖器恶性黑色素瘤预后差。其治疗以手术为主，并辅以化疗和免疫疗法的综合治疗。     

59例Ⅰ期子宫内膜癌的治疗分析

为探讨Ⅰ期子宫内膜癌更为合理的治疗方案，方法将５９例Ⅰ期子宫内膜癌患者随机分为两组：第１组３０例，单纯全子宫，双附件切除加辅助治疗；第２组２９例，行全子宫，双附件切除加盆腔淋续清扫或活检。结果第１组中死亡２例，２年和５年的存活率均为９６．６％平均生存６９．７个月。第２组中死亡３例。     

子宫内膜癌Ⅳb期临床特征和预后分析

目的：分析Ⅳｂ期子宫内膜癌的临床特征,探讨与其预后的相关因素。方法：回顾性分析Ⅳｂ期子宫内膜癌的临床病理特征及随访结果。结果： １１例子宫内膜癌Ⅳｂ期患者,平均 ６１． １岁,绝经 ９例,平均绝经 １４．９年。临床症状主要是绝经后阴道不规则出血或血性分泌物（９／１１）,其次为腹胀（４／１１）、腹部包块（３／１１）,出现症状至就诊平均 １５．１个月。 １０例手术治疗, １例拒绝手术,仅行内分泌治疗,８例行术中、术后化疗,３例术后放疗;平均随访 １２．９个月,死亡 ６例,２年生存率 ２８％,３年生存率 １４％。盆腹腔复发 ３例均死亡,平均存活 ６．７个月,发生肺转移５例,３例死亡,平均存活１４．７个月。术后残存病灶＞２ｃｍ ４例,均因复发转移死亡,平均存活９个月,术后无残存病灶３例均存活。结论：Ⅳｂ期子宫内膜癌患者年龄较大,就诊较晚,多表现为绝经后不规则阴道出血,治疗以手术为主,尽可能切除所有病灶,并辅助放化疗,但预后较差,其相关因素主要有首次手术的彻底性,宫旁血管淋巴管受侵,病灶范围及复发转移部位等。     

生殖系统原发性恶性淋巴瘤15例临床分析

回顾分析１９８０～１９９４年收治的１５例女性生殖系统原发性恶性淋巴瘤，７例发生于宫颈，２例发生于阴道，３例发生于卵巢，另外，外阴、子宫内膜和盆腔各１例。分别给予综合治疗，８例行放疗加化疗，３例行手术加放疗加化疗，３例卵巢恶性淋巴瘤行手术加化疗，１例盆腔恶性淋巴瘤行手术加放疗。结果：２例生存＞５年，３例生存＞３年，６例１年内恶化或死亡，４例治疗后不到２年，仍在随访中。提示：卵巢恶性淋巴瘤较生殖系其它部位的淋巴瘤预后差。化疗－放疗－化疗的序贯治疗适合于宫颈、阴道、外阴的淋巴瘤治疗；对于高度恶性的淋巴瘤应选择高强度的化疗，对伴有较大宫颈肿瘤的患者，应及早放疗。     

卵巢交界性上皮性肿瘤的治疗方式及预后

分析１９６５～１９９２年卵巢交界性上皮性肿瘤２０例的临床资料及随访结果。其中浆液性９例，粘液性ＩＩ例。临床Ｉ期１５例，ＩＩ期３例，ＩＩＩ期２例。１２例行全子宫及单侧或双侧附件切除，其中２例死于肿瘤复发。８例行单侧附件切除，无死于肿瘤复发者。１４例进行术后化疗，现１２例仍存活，占９２．３％；死亡２例，１例为ＩＩＩ期患者，另１例死于其他疾病。未化疗者６例，其中３例Ｉａ期患者健在；死亡１例，为Ｉｂ期。结果提不：预后与手术方式关系不密切，而与分期有关；对具有高危因素，如外生乳头、肿瘤破裂、腹水等患者，以进行化疗为宜。     

应用阴道模板行组织间放射治疗阴道狭窄型子宫颈癌

目的：探讨以阴道模板组织间放射治疗（放疗）的方法代替传统腔内放疗，用于治疗阴道狭窄型子宫颈癌的效果。方法：采用的治疗容器（阴道模板）分为前后两部分。前部有洞孔，可引导放射源插入宫颈及穹窿部。模板的直径为２．０～３．５ｃｍ，可在周围放置６～８支铯针或８支周边铯针加１支中央铯针。每针放射源强度为８ｍＣｉ，全长５．５ｃｍ。阴道模板前后两部分可互锁，以保证模板全长置于阴道以及放射源的固定。插植过程行全身麻醉。我们对１９８７年７月至１９９１年６月间１２例阴道狭窄型宫颈癌患者进行了此种阴道模板组织间放疗，并配合体外盆腔照射。结果：１２例中，１例出现中心性复发并死于间发症；２例无瘤生存２６．２～４１．９个月，死于间发症；余９例局部无瘤生存２３．７～４１．９个月。结论：应用阴道模板行组织间放疗是一种适用于阴道狭窄型宫颈癌的治疗方法。     

子宫颈转移癌19例临床分析

目的：分析子宫颈转移癌的临床特点及治疗情况。方法：回顾性分析我院１９５９年至１９９４年收治的１９例子宫颈转移癌病例。结果：１９例子宫颈转移癌患者的平均年龄为４３．７岁。主要症状为阴道排液和（或）阴道不规则出血（占６８．４％）；原发瘤多为消化道肿瘤及卵巢癌。治疗方法包括单纯放疗、手术后放疗及化疗、手术后放疗。根据寿命表法计算，１年、２年及５年生存率分别为６８．５％，４７．３％及２６．２％，存活最长１例已达２２年。结论：如原发灶肿瘤获得满意治疗，转移瘤仅局限于宫颈并对放疗敏感者，可获得较好的疗效     

卵巢交界性肿瘤的临床特征及治疗

目的明确卵巢交界性肿瘤（交界性瘤）的临床特征及治疗方法。方法对３５年来收治的７０例卵巢交界性瘤患者进行回顾性分析。结果患者年龄１６～７６岁,平均４５．６岁。组织类型粘液性４６例（６５．７％）,浆液性２１例（３０％）;临床分期Ⅰ期４６例（６５．７％）,Ⅱ期１例（１．４％）,Ⅲ期１１例（１５．７％）,无Ⅳ期患者。治疗后复发１２例（１７．１％）。ＣＡ１２５升高１１例（１１／２１）,癌胚抗原（ＣＥＡ）升高６例（６／１０）。治疗以手术为主,４５例术后接受辅助治疗。７０例中无瘤存活４５例,带瘤存活４例,死于交界性瘤１１例,死于其他原因１０例。１１例行单侧附件切除的Ⅰ期患者均无瘤存活。１６例术后有肿瘤残留并接受辅助治疗者中完全缓解２例。全组５年、１０年、２０年、３０年存活率分别为９０．０％、８７．１％、８７．１％和８５．６％。多因素分析显示,组织学类型、期别和术后肿瘤残留,是影响预后的主要因素。结论粘液性瘤所占比例明显高于浆液性瘤;手术治疗是交界性瘤有效的治疗手段,应力求将肿瘤完全切除;术后辅助治疗不能改善交界性瘤患者的预后;ＣＡ１２５和ＣＥＡ对于交界性瘤监测有一定意义     

Ⅰb和Ⅱa期子宫颈癌的手术治疗

回顾性复习经手术治疗的子宫颈浸润癌１２４例，包括鳞癌２８例、腺癌３０例、腺鳞癌３例及未分化癌２例。其中１８例术前期别估计低于术后（１４．５％）。Ⅰ期和Ⅱ期病例均有不同比例的宫体和盆腔淋巴结转移，但无１例卵巢转移。有１７例６０岁或以上患者接受广泛性子宫切除及盆腔淋巴结清扫术，未见手术并发症显著升高。提示：术前准确估计期别是影响手术治疗的重要因素，对包括腺癌的Ⅰｂ期病例手术可予保留卵巢，老年妇女并非为     

外阴癌两种手术方式的比较

对１９５８年７月至１９９０年１２月，在中国医学科学院肿瘤医院住院治疗的８８例外阴癌病例作回顾性分析。８８例均行根治性外阴切除术和双侧腹股沟淋巴结切除术。根据手术方式分为整块切除（２５例）和非整块切除（６３例）。两组五年生存率分别为７６．０％和７９．８％，术后并发症的发生率为７２．０％和７１．４％，而切口愈合时间非整块切除组较整块切除组提早１４．４天。本研究着重探讨了改进手术方式的可行性。同时，本文讨论了晚期患者的综合治疗方法。     

外阴转移性肿瘤78例临床报告

目的 了解外阴转移性肿瘤的临床特点,探讨其诊断及治疗方法,方法 回顾性分析１９５８～１９９５年收治的７８例外阴转移性肿瘤患者,其中宫颈癌转移６１例（７８．２％）尿癌转移５例,阴道癌转移４例子宫内膜癌转移３例,乳腺癌转移２例,卵巢癌,直肠癌,恶性淋巴转移各１例,结果 患者中位年龄５５岁,７５．６％（５９／７８）转移瘤在原发肿瘤诊断之后的１５天至１８年发现,中位间隔时间为２．５年,６１．５％（４８／７     

阴道上皮内瘤变13例临床分析

目的 探讨阴道上皮内瘤变(VAIN)的病因、临床特点、诊断、治疗及预后.方法 回刎顾性分析浙江省肿瘤医院2002年3月至2008年12月收治的13例VAIN患者的临床资料,其中2例为VAINⅡ、11例为VAINⅡ～Ⅲ或VAINⅢ.结果 13例VAIN患者中,行人乳头状瘤病毒(HPV)检测12例,其阳性率为92%(11/12).VAIN临床表现无特异性,1例阴道分泌物增多;4例阴道局部糜烂充血或呈乳头状增生,2例小结节状改变.13例VAIN患者中,合并宫颈癌6例、宫颈上皮内瘤变(CIN)4例外阴上皮内瘤变(VIN)3例;与宫颈病变(包括宫颈癌和CIN)同时确诊5例、与外阴病变(即VIN)同时确诊3例,其余5例均在复查这些疾病时确诊.与宫颈病变或外阴病变同时确诊的8例VAIN患者采用手术治疗,其中l例VAIN合并CIN因病变广泛术后补充氩气刀治疗,1例VAIN合并VIN因术后切缘阳性补充氩气刀治疗;1例中晚期宫颈癌行同步放化疗后随访时发现的VAIN患者行根治性放疗;3例术后随访时发现的VAIN(VAINⅡ、VAINⅡ～Ⅲ、VAINⅢ各1例)行氩气刀治疗;1例官颈癌Ⅲb期合并VAINⅢ患者治疗.本组患者的平均随访时间为25.6个月(6～87个月),2例患者因官颈癌发生远处转移而死亡,11例活检或阴道液基薄层细胞学检查(TCT)无异常,随访期内无一例进展为浸润癌.结论 HPV感染是VAIN发病的主要原因;VAIN的临床表现隐匿,多在治疗或复查宫颈病变、外阴病变时确诊;治疗以手术为主;VAIN很少进展为浸润癌,预后较好.     

Surgical treatment of invasive carcinoma of the vulva. Our experience

OBJECTIVE: The purpose of this study was to investigate the clinical findings, treatment and outcome of patients with vulvar carcinoma in the L'Aquila area. METHODS: Fifteen cases of vulvar carcinoma seen between September 1991 and December 1999 at the Department of Obstetrics and Gynecology of the University of L'Aquila were reviewed. Clinical, pathologic, surgical and follow-up data were collected from patient records. Mean age at diagnosis was 66.4 years. All patients were evaluated through a careful medical history and physical examination, vulvoscopy, abdomino-pelvic CT or MR, urethrocystoscopy, rectocolonscopy and SCC, and CEA determination. Radical surgery included six patients treated by the Taussig-Way operation. Modified radical surgery accounted for nine patients treated by the Byron three-incision approach. RESULTS: The major early complication was groin wound breakdown which occurred in four cases. The major late complication was chronic leg edema which was reported in six patients. The average number of nodes removed per patient was 19.5. Seven patients (46.7%) had a T2N0M0 pathologic stage, four (26.7%) were T2N1M0, four (26.7%) T1N0M0. Five patients died of local and distant recurrences within 37 months after surgical treatment; ten patients are alive, nine are apparently free from disease whereas one presented local and systemic recurrence within 18 months after surgery. CONCLUSIONS: Vulvar carcinoma predominantly affects older women. Most patients in our series (11/15) had tumors more than 2 cm in diameter. Although the vulva is an external organ and early detection should be achieved, many patients presented with extensive primary lesions due to both patient and physician delay. Stage of disease, tumor size, and nodal metastases are potential prognostic factors useful in selecting patients for a more conservative surgical approach.     

Merkel cell carcinoma of the Bartholin's gland

BACKGROUND: There are a few cases of "small cell neuroendocrine carcinoma" of the Bartholin's gland as well as Merkel cell carcinoma of the vulva reported in the gynecologic oncology literature, most with aggressive clinical behavior. Merkel cells were originally described in the epidermis with neuroendocrine properties. Merkel cell carcinoma is different from the neuroendocrine small cell (oat cell) tumor arising in the lung and other internal organs based on morphology and immunohistochemistry. CASE: A 49-year-old female was diagnosed with a FIGO stage I Merkel cell carcinoma of the Bartholin's gland. The tumor originated from the duct and stained with endocrine markers and cytokeratin 7 and 20. She was treated with radical wide local excision and bilateral inguinal lymph node dissection followed by radiation therapy to the pelvis, perineum, vulva, and inguinal regions. Two years after the diagnosis, she is alive with no evidence of recurrent disease. CONCLUSION: This is a case of Merkel cell carcinoma of the Bartholin's gland discovered in the early stage with a survival of 2 years following diagnosis and treatment with no evidence of disease recurrence.     

Squamous cell carcinoma with sarcomatoid features of the vulva: a case report and review of literature

BACKGROUND: A squamous cell carcinoma with sarcomatoid features of the vulva is an extremely rare malignancy of the female genital tract. This type of tumor is known to grow rapidly and associated with poorer clinical outcomes than those of squamous cell carcinoma of the vulva. CASES: A 43-year-old woman presented to our institute with a 4-month history of an aggravated vulvar mass. A radical local excision, bilateral inguinal lymph node dissection and laparoscopic assisted vaginal hysterectomy were performed. The FIGO stage of the vulvar cancer was stage II (T(2)N(0)M(0)) and the pathologic finding was consistent with a poorly differentiated squamous cell carcinoma with extensive sarcomatoid features. No further treatment was given and there was no clinical evidence of recurrence during the 2 years of follow-up. CONCLUSION: A squamous cell carcinoma with sarcomatoid features of the vulva is a tumor with aggressive biological behavior. To date, there have been only 15 cases of this disease reported in the literature. So, a collection and close study of these cases would be extremely useful in singling out and identifying the best treatment possible for this type of tumor.     

晚期子宫内膜癌预后相关因素分析

目的 探讨晚期子宫内膜癌预后相关因素。方法 回顾性分析我院1986年1月～1999年9月间收治的41例晚期子宫内膜癌患者临床病理资料和随访结果。结果(1)41例患者,Ⅲ期30例,其中Ⅲa期15例(36.6％),Ⅲb期3例(7.3％),ⅢC期12例(29.3％),Ⅳ期11例(26.8％)(均为Ⅳb期);子宫内膜样腺癌30例(73.2％),腺鳞癌5例(12.2%),浆乳癌5例(12.2%),透明细胞癌1例(2.4%);单纯手术2例,单纯放疗3例,单纯孕激素治疗1例,综合治疗35例;死亡17例,5年生存率35.4％。(2)Ⅲ期患者中,Ⅲa期复发3例,死亡2例,5年生存率65.6％;Ⅲb期盆腹腔复发1例(死亡),Ⅲc期复发转移8例,均死亡,5年生存率14.5％。(3)Ⅳ期患者中,盆腹腔复发3例,肺转移5例,死亡6例,3年生存率 27.7％。(4)子宫外多处癌灶22例,其中复发转移16例,死亡14例,占全部死亡的82.4％。结论 子宫内膜癌Ⅲc期预后明显差于Ⅲa期,子宫浆膜受侵、子宫外多处癌灶、宫旁组织受侵犯、宫旁淋巴管或血管有癌栓及淋巴结癌转移仍是影响Ⅲ期子宫内膜癌预后的重要因素,Ⅳ期患者易盆腹腔复发和肺转移,预后更差,晚期子宫内膜癌应进行综合治疗。     

原发性宫颈恶性黑色素瘤13例临床分析

目的： 提高对原发性宫颈恶性黑色素瘤的认识及治疗水平。方法： 回顾性分析2013年1月—2019年12月郑州大学附属肿瘤医院收治的13例经病理确诊为原发性宫颈恶性黑色素瘤患者的病例资料,分析其临床特征、治疗及预后情况。结果： 13例患者年龄30~64岁,平均（51.1±10.8）岁,国际妇产科联盟（International Federation of Gynecology and Obstetrics,FIGO）2018版分期Ⅰ期4例,Ⅱ期3例,Ⅲ期1例,Ⅳ期5例。6例ⅠA~ⅡA期患者行手术治疗,其中2例仅观察,3例术后接受化疗,1例接受化疗+免疫治疗。2例ⅡB~Ⅲ期患者及2例Ⅳ期患者接受放疗+化疗。其余3例Ⅳ期患者接受化疗、局部放疗、免疫治疗或靶向治疗的综合治疗。中位随访时间12个月（7~84个月）,9例死亡,3例远处转移,中位总生存期38个月。结论： 原发性宫颈恶性黑色素瘤是一种较为罕见但恶性程度极高的肿瘤,预后差,易远处转移。手术切除是早期患者的主要治疗方式,不能进行根治性手术的患者可选择免疫及靶向治疗的综合治疗方法。     

Basal cell carcinoma of the vulva

Four cases of basal cell carcinoma of the vulva are presented with case histories and treatment. One death is recorded due to postoperative cardiac failure and pulmonary edema following a Basset operation two years after the preliminary vulvectomy. At the time of the gland removal there was no evidence of any local recurrence. The other 3 patients are alive and well, eight years, nine years, and six months, respectively. All were treated by surgical extirpation without radiation. Three patients had a regional lymph gland removal, but in no case was there any evidence of any metastasis.     

Granular cell tumors of the vulva

OBJECTIVE: The objective of this study was to review clinical characteristics, histologic findings, and recommendations for surgical treatment of patients with granular cell tumors of the vulva.STUDY DESIGN: A retrospective study of 20 patients diagnosed with a granular cell tumor of the vulva from December 1963 to June 1994 was undertaken to evaluate age, lesion location, size, histopathologic features, presenting symptoms, progression of disease, and treatment.RESULTS: The average age was 50 years, with a range of 26 to 78 years. Fourteen of the 20 patients were black and six were white. Lesions were identified on the labia majora (18), on the clitoris (one), and in the perineal region (one). Only two patients had multiple lesions. Presenting complaints included increasing growth of the lesion (nine), pain (three), and pruritus (one). Six patients were asymptomatic. Lesion size ranged from 0.4 × 0.4 cm to 7 × 8 × 12 cm. Two lesions were found to infiltrate surrounding connective tissue. The 12 lesions that were stained for S-100 protein all had positive results. Nineteen patients were treated with wide local excision only. The twentieth patient required radical surgery because of the large size of the lesion; she died with pulmonary metastasis.CONCLUSION: Granular cell tumors of the vulva are slow-growing, predominantly solitary tumors that are commonly asymptomatic. The tumors originate at the neural crest, as demonstrated by S-100 staining. The majority of lesions are benign and may be treated with conservative wide local excision. An extremely uncommon histologically benign but clinically malignant form of granular cell tumor of the vulva needs special attention.