卵巢纤维卵泡膜细胞瘤误诊为卵巢恶性肿瘤1例报告及文献复习

doi:10.13481/j.1671-587x.20190435

摘要/Abstract

摘要： 目的：分析并发腹水和高水平糖类抗原125（CA125）的卵巢纤维卵泡膜细胞瘤患者的临床特点，探讨CA125水平升高的原因及其在鉴别卵巢良恶性肿瘤方面的意义。方法：收集1例并发腹水及高水平血清CA125的卵巢纤维卵泡膜细胞瘤患者的临床资料，结合相关文献，分析其临床特点、诊治过程及血清CA125水平在鉴别卵巢良恶性肿瘤中的意义。结果：患者因阴道流血4个月，检查发现盆腔包块1个月入院，结合术前彩超、增强CT、血清CA125水平及查体诊断为盆腹腔肿物，考虑为卵巢来源，高度怀疑为卵巢恶性肿瘤。给予手术治疗，术中快速病理和术后慢病理明确诊断为卵巢纤维卵泡膜细胞瘤，手术过程顺利。患者恢复良好出院，术后1个月复查血清CA125水平已降至正常范围。结论：对不同来源CA125糖基化修饰和特异性糖链结构的鉴定以及定量分析，可以明显提高CA125对卵巢良恶性肿瘤的诊断特异性。

关键词: 卵巢纤维卵泡膜细胞瘤, 卵巢肿瘤, 糖类抗原125, 腹水

Abstract: Objective:To analyze the clinical features of ovarian fibrothecoma complicated with ascites and high level of CA125, and to explore the causes of elevated CA125 level and its significance in identifying benign and malignant ovarian tumors. Methods:The clinical data of one patient with varian fibrothecoma complicated with ascites and high level of serum CA125;combined with relevant literature review, the clinical characteristics, diagnosis and treatment process, and the significance of CA125 in the differential diagnosis of benign and malignant ovarian tumors were analyzed. Results:The patient was admitted to hospital due to vaginal bleeding for 4 months and pelvic mass for 1 month. The diagnosis result was pelvic and abdominal mass arising from ovarian according to the preoperative color Doppler ultrasound, enhanced CT, serum CA125 level and physical examination,and was highly suspected as ovarian malignant tumor. Surgery treatment was performed; based on the intraoperative rapid pathological results and postoperative slow pathology, the patient was diagnosed as ovarian fibrothecoma; the operation was successful. The patient recovered well and discharged from hospital.The serum CA125 level was decreased to the normal range 1 month after operation. Conclusion:Identification and quantitative analysis of the glycosylation modification and specific glycan structure of CA125 from different sources can significantly improve the diagnostic specificity of CA125 for benign and malignant ovarian tumors.

Key words: ovarian fibrothecoma, ovarian neoplasms, carbohydrate antigen 125, ascites

中图分类号:

R737.31

裴燕岭, 吕航航, 王博蔚, 张炜旸. 卵巢纤维卵泡膜细胞瘤误诊为卵巢恶性肿瘤1例报告及文献复习[J]. 吉林大学学报(医学版), 2019, 45(04): 940-943.

PEI Yanling, LYU Hanghang, WANG Bowei, ZHANG Weiyang. Misdiagnosis of ovarian fibrothecoma as ovarian malignant tumor: A case report and literature review[J]. Journal of Jilin University(Medicine Edition), 2019, 45(04): 940-943.

参考文献

[1] NUMANOGLU C,KURU O,SAKINCI M,et al.Ovarian fibroma/fibrothecoma:Retrospective cohort study shows limited value of risk of malignancy index score[J].Aust N Z J Obstet Gynaecol,2013,23(4):79-83.
[2] 周玮,何剑,沈建,等. 卵巢纤维卵泡膜细胞瘤的影像学表现[J].中国医学科学院学报,2015,37(4):378-383.
[3] 康林英,刘佳,张国福,等. 卵巢卵泡膜纤维瘤的MRI诊断[J]. 中国医学计算机成像杂志,2012,18(5):428-430.
[4] OWEN D,ANDREWS M H,MATTHEWS S G. Maternal adversity,glucocorticoids and programming of neuroendocrine function and behaviour[J].Neurosci Biobehav R,2005,29(2):209-226.
[5] BAST R C,FEENEY M,LAZARUS H,et al. Reactivity of mono-clonal antibody with human ovarian carcinoma[J]. J Clin Invest, 1981, 68(5):1331-1337.
[6] 杨冬梅,董源芬. 肿瘤标志物CA125检测在卵巢疾病诊断中的应用[J].中国妇幼保健,2013,28(4):706-707.
[7] WEINTRAUB J,BISHOF P,TSENG L,et al. CAl25 is anexcretory product of human endometrial glands[J]. Biol Reprod, 1990, 42(1):721-726.
[8] CHUNG H H,KIM J W,PARK N H,et al. Use of preoperative serum CA125 levels for prediction of lymph node metastasis and prognosis in endometrial cancer[J]. Acta Obstet Scand, 2006, 85(12):1501-1505.
[9] 沈铿,马丁. 妇产科学[M].北京:人民卫生出版社,2015:440-443.
[10] BOUVARD V,ZAITCHOUK T,VACHER M,et al.Tissue and cell specific expression of the p53-target genes:bax,fas,mdm2 and waf1/p21,before and following ionising irradiation in mice[J]. Oncogene, 2000, 19(5):649-660.
[11] YEMELYANOVA A,VANG R,KSHIRSAGAR M,et al. Immunohistochemical staining patterns of p53 can serve as a surrogate maker for TP53 mutations in ovarian carcinoma:an immunohistochemical and nucleotide sequencing analysis[J]. Mod Pathol,2011,24(9):609-615.
[12] PAVLA B,THIEL K W,LESLIE K K. The consequence of oncomorphic TP53 mutations in ovarian cancer[J]. Int J Mol Sci, 2013, 14(9):19257-19275.
[13] ROH M H,YASSIN Y,MIRON A,et al. High-grade fimbrial-ovarian carcinomas are unified by altered p53, PTEN and PAX2 expression[J]. Mod Pathol,2010, 23(10):1316-1324.
[14] 佐晶. 热休克蛋白及p53的表达与晚期卵巢浆液性腺癌预后的相关性研究[D].北京:北京协和医学院,2016.
[15] YIN B W T,LIOYD K O. Molecular cloning of the CA125 ovarian cancer antigen-identification as a new mucin, MUC16[J]. J Biol Chem, 2001, 276(29):27371-27375.
[16] 徐丛剑,王宜生,杨子健. CA125在卵巢癌诊断中的应用困境与突破[J].中国实用妇科与产科杂志,2016,32(5):417-421.
[17] HAKOMORI S,CUMMINGS R D.Glyeosylation effects on cancer development[J]. Glycoconjugate J,2012,29(8/9):565-566.
[18] KITADA T,MIYOSHI E,NODA K,et al. The addition of bisecting N-acetylglucosamine residues to E-cadherin down-regulates the tyrosine phosphorylation of beta-catenin[J]. J Biol Chem, 2001, 276(1):475-480.
[19] TUCCILLO F M,de LAURENTⅡS A,PALMIERI C,et al.Aberrant glycosylation as biomaker for cancer:focus on CD43[J]. Biomed Res Int,2014,2014:742831.
[20] WONG N K,EASTON R L,PANICO M,et al. Characterization of the oligosaccharides associated with the human ovarian tumor marker CA125[J]. J Biol Chem, 2003, 278(31):28619-28634.
[21] WANG P H,LEE W L,JUANG C M,et al. Altered mRNA expressions of sialyltransferases in ovarian cancers[J]. Gynecol Oncol, 2005,99(3):631-639.
[22] ALDREDGE D,AN H J,TANG N,et al.Annotation of a serum N-glycan library for rapid identification of structures[J]. J Proteome Res,2012,11(3):58-68.
[23] 薛添,李艳红,李铮.卵巢癌生物标志物的糖链谱研究进展[J].生物化学与生物物理进展,2017,44(10):865-876.
[24] YEN P,KHONG K,LAMBA R,et al. Ovarian fibromas and fibrothecomas:sonographic correlation with computed tomography and magnetic resonance imaging:a 5-year single-institution experience[J]. J Ultrasound Med,2013,32(1):13-18.
[25] CHO Y J,LEE H S, KIM J M,et al.Clinical characteristics and surgical management options for ovarian fibroma/fibrothecoma:a study of 97 cases[J].Gynecol Obstet Invest, 2013,76(3):182-187.
[26] TING Y,YANG L,JUAN Z,et al.Ovarian thecoma with massive pleural effusion in postmenopausal women:A case report[J]. Mol Clin Oncol,2016,4(6):1003-1005.