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中华医学超声杂志(电子版) ›› 2023, Vol. 20 ›› Issue (01) : 41 -45. doi: 10.3877/cma.j.issn.1672-6448.2023.01.007

妇产科超声影像学

卵巢卵黄囊瘤的声像图特征、临床病理与预后分析
项文静1, 茹彤1, 徐学翠1, 刘柳柳2, 杨燕1,()   
  1. 1. 210008 南京大学医学院附属鼓楼医院妇产科超声室
    2. 210008 南京大学医学院附属鼓楼医院妇产科
  • 收稿日期:2021-08-09 出版日期:2023-01-01
  • 通信作者: 杨燕
  • 基金资助:
    基于健康管理大数据平台的卵巢肿瘤超声诊断的应用研究(BJ19004)

Ultrasonographic, clinicopathologic, and prognostic features of ovarian yolk sac tumor

Wenjing Xiang1, Tong Ru1, Xuecui Xu1, Liuliu Liu2, Yan Yang1,()   

  1. 1. Department of Gynecologic Ultrasound, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
    2. Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
  • Received:2021-08-09 Published:2023-01-01
  • Corresponding author: Yan Yang
引用本文:

项文静, 茹彤, 徐学翠, 刘柳柳, 杨燕. 卵巢卵黄囊瘤的声像图特征、临床病理与预后分析[J/OL]. 中华医学超声杂志(电子版), 2023, 20(01): 41-45.

Wenjing Xiang, Tong Ru, Xuecui Xu, Liuliu Liu, Yan Yang. Ultrasonographic, clinicopathologic, and prognostic features of ovarian yolk sac tumor[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(01): 41-45.

目的

分析并总结卵巢卵黄囊瘤(OYST)的声像图特征、临床病理特点及预后。

方法

回顾性分析2010年1月至2020年12月在南京大学医学院附属鼓楼医院行超声检查、经手术病理证实的OYST患者10例,记录患者的临床资料、声像图特点、病理结果及分期、治疗方式及预后。通过与病理结果进行对照,分析各例患者超声特点,总结能够提示OYST的主要或特定声像图特征。

结果

OYST患者年龄偏小(≤30岁),肿块体积大(最大径94~265 mm),肿瘤内部回声以实性为主,常单侧发病,形状规则,血流信号丰富,甲胎蛋白常异常增高(多数>1000 ng/ml)。10例OYST患者均选择手术治疗,其中1例患者手术后因肿瘤全身转移伴盆腔脓肿死亡,1例合并妊娠者足月顺产一健康婴儿。2例Ⅲ A期患者死亡,2例Ⅲ C期及6例Ⅰ C期患者均无瘤生存,其中6例患者保留生育功能,化疗后3个月内均恢复正常月经,3例患者已完成生育,生育子女健康。

结论

OYST具有某些特定的超声征象,正确认识其声像图特征并结合相关临床及实验室检查,对于该病的术前评估至关重要。

Objective

To analyze and summarize the ultrasonographic, clinicopathologic, and prognostic features of ovarian yolk sac tumor (OYST).

Methods

Ten patients with OYST confirmed by ultrasonography at Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School from January 2010 to December 2020 were analyzed retrospectively. The clinical data of the patients were recorded. Ultrasonographic characteristics, pathological results, tumor stage, treatment, and prognosis were also recorded. The ultrasonographic characteristics of each case were analyzed to identify the main or specific ultrasonographic characteristics indicating OYST.

Results

The patients with OYST were young (≤30 years old) and had large masses (maximum diameter 94~265 mm). The internal echo was mainly solid; the tumor was usually unilateral and regular in shape, and had abundant blood flow signal. There was often an abnormal increase of alpha-fetoprotein (>1000 ng/ml). All the ten OYST patients underwent surgical treatment, among which one died after surgery due to systemic tumor metastasis accompanied by pelvic abscess, one with pregnancy gave birth to a healthy baby, two having stage ⅢA disease died, and two having stage ⅢC and six with stage ⅠC disease had disease-free survival, among which six had preserved fertility function and returned to normal menstruation within 3 months after chemotherapy, and six gave birth to healthy children.

Conclusion

OYST has some specific ultrasonic signs, and identification of its sonographic features combined with related clinical and laboratory examinations is of great importance for preoperative evaluation of this disease.

图1 卵巢肿块血流分级超声声像图。图a:患者19岁,卵巢颗粒细胞瘤,内部以囊性为主,血流分级:0级;图b:患者22岁,卵巢黏液性交界性局灶癌变(中分化),内部以囊性为主,血流分级:Ⅰ级;图c:患者11岁,混合性恶性生殖细胞肿瘤(卵黄囊瘤、畸胎瘤、胚胎性癌各占40%、40%、20%),内部以实性为主,血流分级:Ⅱ级;图d:患者22岁,卵巢卵黄囊瘤伴大量坏死,内部以实性为主,血流分级:Ⅲ级
图2 患者女性,24岁,卵巢混合性恶性生殖细胞肿瘤(卵黄囊瘤占40%,无性细胞瘤占60%),部分境界不清晰,形状规则,内部以实性为主,彩色多普勒示血流丰富注:LMASS为左侧附件区肿块
表1 卵巢卵黄囊癌患者基本临床资料、声像图特征及肿瘤标志物异常
图3 患者女性,19岁,卵巢低级别浆液性腺癌,边界清晰,形状规则,内部以囊性为主,内有密集光点,彩色多普勒示分隔上见中量血流信号注:MASS为附件区肿块
图4 卵巢颗粒细胞瘤彩色多普勒血流成像图。图a:患者女性,25岁,左侧附件区见一囊性为主肿块,境界不清晰,形状规则,彩色多普勒见血流信号丰富;图b:患者女性,19岁,左侧附件区见一实性为主肿块,境界清晰,形状规则,彩色多普勒见血流信号丰富注:L-MASS为左侧附件区肿块,MASS为附件区肿块
图5 卵巢卵黄囊瘤的内胚窦样结构(HE×100)
1
Wang Y, Yang JX, Yu M, et al. Ovarian yolk sac tumor in postmenopausal females: a case series and a literature review [J]. Medicine ( Baltimore), 2018, 97(33): e11838.
2
鲁丽, 王秀河. MRI诊断卵巢内胚窦瘤合并成熟性囊性畸胎瘤一例 [J]. 临床放射学杂志, 2016, 35(4): 503-504.
3
朱玉春, 王建良, 张怀信, 等. 右侧卵巢卵黄囊瘤伴囊性畸胎瘤一例 [J]. 临床放射学杂志, 2016, 35(7):1002-1003.
4
Li YK, Zheng Y, Lin JB, et al. CT imaging of ovarian yolk sac tumor with emphasis on differential diagnosis [J]. Sci Rep, 2015, 15(5): 11000.
5
Adler DD, Carson PL, Rubin JM, et al. Doppler ultrasound color flow imaging in the study of breast cancer: preliminary findings [J]. Ultrasound Med Biol, 1990, 16(6): 553-559.
6
陈秋梅, 叶裕丰, 袁晓芸, 等. 多种影像检查结合AFP对卵黄囊瘤诊断的价值 [J]. 现代医用影像学, 2019, 28(3): 533-535.
7
徐炼, 王巍, 何英, 等. 卵巢卵黄囊瘤46例临床病理分析 [J]. 四川大学学报(医学版), 2018, 49(4): 680-682.
8
Prat J, FIGO Committee on Gynecologic Oncology. Staging classification for cancer of the ovary, fallopian tube, and peritoneum [J]. Int J Gynaecol Obstet, 2014, 124(1): 1-5.
9
Jung SE, Lee JM, Rha SE, et al. CT and MR imaging of ovarian tumors with emphasis on differential diagnosis [J]. Radiographics, 2002, 22(6): 1305-1325.
10
Li Y, Zheng Y, Lin J, et al. Radiological-pathological correlation of yolk sac tumor in 20 patients [J]. Acta Radiol, 2016, 57(1): 98-106.
11
杜居洁, 郑红. 18例卵巢颗粒细胞瘤超声表现 [J/CD]. 中华医学超声杂志(电子版), 2010, 7(10): 1740-1742.
12
桂阳, 杨萌, 苏娜, 等. 卵巢无性细胞瘤的超声表现 [J/CD]. 中华医学超声杂志(电子版), 2018, 15(5): 343-348.
13
Choi HJ, Moon MH, Kim SH, et al. Yolk sac tumor of the ovary: CT findings [J]. Abdom Imaging, 2008, 33(6): 736-739.
14
Yamaoka T, Togashi K, Koyama T, et al. Yolk sac tumor of the ovary: radiologic-pathologic correlation in four cases [J]. J Comput Assist Tomogr, 2000, 24(4): 605-609.
15
Shaaban AM, Rezvani M, Elsayes KM, et al. Ovarian malignant germ cell tumors: cellular classification and clinical and imaging features [J]. Radiographics, 2014, 34(3): 777-801.
16
林满霞, 徐辉雄, 谢晓燕, 等. 睾丸卵黄囊瘤的超声表现 [J/CD]. 中华医学超声杂志(电子版), 2008, 5(3): 406-411.
17
Terentiev AA, Moldogazieva NT. Alpha-fetoprotein: a renaissance [J]. Tumour Biol, 2013, 34(4): 2075-2091.
18
Zhao Q, Yang J, Cao D, et al. Tailored therapy and long-term surveillance of malignant germ cell tumors in the female genital system: 10-year experience [J]. J Gynecol Oncol, 2016, 27(3): e26.
19
Nasioudis D, Chapman-Davis E, Frey MK, et al. Management and prognosis of ovarian yolk sac tumors; an analysis of the National Cancer Data Base [J]. Gynecol Oncol, 2017, 147(2): 296-301.
20
Cicin I, Saip P, Guney N, et al. Yolk sac tumours of the ovary: evaluation of clinicopathological features and prognostic factors [J]. Eur J Obstet Gynecol Reprod Biol, 2009, 146(2): 210-214.
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