李雷;冯凤芝;范融;娄文佳;李源;仝佳丽;常晓燕;潘凌亚;
LI Lei;FENG Feng-zhi;FAN Rong;LOU Wen-jia;LI Yuan;TONG Jia-li;CHANG Xiao-yan;PAN Ling-ya;Department of Obstetrics and Gynecology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Pathology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

• 1:中国医学科学院北京协和医学院北京协和医院妇产科
• 2:中国医学科学院北京协和医学院北京协和医院病理科

摘要(Abstract)：

目的分析卵巢非侵袭性低级别浆液性癌(low-grade serous carcinoma,LGSC)患者保留生育功能手术的特点。方法回顾性收集2015年1月至2015年6月北京协和医院病理诊断为卵巢非侵袭性LGSC且进行保留生育功能手术的患者,对其临床病理特点、手术过程和随访情况进行总结。结果共有5例非侵袭性LGSC且保留生育功能患者,中位年龄29岁(24³4岁);1例行开腹手术,4例行腹腔镜手术;4例手术行卵巢囊肿剔除,1例患者因为卵巢急性扭转坏死行受累附件切除。1例国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)分期为IB期,4例为IA期。所有患者术后均未接受进一步治疗。中位随访7个月(634岁);1例行开腹手术,4例行腹腔镜手术;4例手术行卵巢囊肿剔除,1例患者因为卵巢急性扭转坏死行受累附件切除。1例国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)分期为IB期,4例为IA期。所有患者术后均未接受进一步治疗。中位随访7个月(6¹2个月),所有患者均未复发,1例患者自然受孕且母胎情况良好。结论对于非侵袭性LGSC患者,能否保留生育功能、保留生育功能手术术后的生育情况、复发率及随诊方案,仍是目前临床处理的棘手问题。本研究为年轻的非侵袭性LGSC患者提供了保留卵巢的选择,但患者的长期预后(包括生育和生存)尚有待进一步随访。
Objective To investigate the characteristics of fertility-sparing surgery for non-invasive lowgrade serous carcinoma( LGSC) of the ovary. Methods All the histologically diagnosed patients of non-invasive LGSC who admitted to Peking Union Medical College Hospital and received fertility-sparing surgeries between January 2015 and June 2015 were reviewed and their clinicopathological characteristics,surgical procedures,and follow-up results were retrospectively analyzed. Results Totally five cases of non-invasive LGSC receiving fertility-sparing surgeries were reviewed. Their median age was 29 years( range,24- 34 years). One case received laparotomy and four received laparoscopies; four cases received ovarian cystectomy and one received emergency unilateral adnexectomy for the affected and necrotic ovary because of acute torsion. One case was diagnosed at International Federation of Gynecology and Obstetrics( FIGO) stage IB,and the other four were at stage IA. All the five cases received no further therapy after the surgery. The median follow-up period was 7 months( range,6- 12 months). No case relapsed so far. One case conceived naturally and both the mother and the fetus were ingood condition. Conclusions For non-invasive LGSC patients,there are many unresolved issues in aspects of spare of fertility,conception after fertility-sparing surgeries,recurrence,and follow-up. Although the possibility to spare the ovary is supported by this study for young non-invasive LGSC patients,long-term prognosis( including fertility and survival) needs to be observed in further follow-up.

关键词(KeyWords)： 卵巢交界性肿瘤;微乳头亚型的浆液性交界性肿瘤/卵巢非侵袭性低级别浆液性癌;保留生育功能手术
ovarian borderline tumor;micropapillary variant of serous borderline tumor/ovarian non-invasive low-grade serous carcinoma;fertility-sparing surgery

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 李雷;冯凤芝;范融;娄文佳;李源;仝佳丽;常晓燕;潘凌亚;
LI Lei;FENG Feng-zhi;FAN Rong;LOU Wen-jia;LI Yuan;TONG Jia-li;CHANG Xiao-yan;PAN Ling-ya;Department of Obstetrics and Gynecology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Pathology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

参考文献(References)：

• [1]Kurman RJ,Carcangiu ML,Herrington CS,eds.World Health Organization Classification of Tumours[M].4 ed.Lyon:International Agency for Research on Cancer,2014.
• [2]Seidman JD,Kurman RJ.Subclassification of serous borderline tumors of the ovary into benign and malignant types.A clinicopathologic study of 65 advanced stage cases[J].Am J Surg Pathol,1996,20:1331-1345.
• [3]Laury AR,Hornick JL,Perets R,et al.PAX8 reliably distinguishes ovarian serous tumors from malignant mesothelioma[J].Am J Surg Pathol,2010,34:627-635.
• [4]Barcena C,Oliva E.WT1 expression in the female genital tract[J].Adv Anat Pathol,2011,18:454-465.
• [5]Escobar J,Klimowicz AC,Dean M,et al.Quantification of ER/PR expression in ovarian low-grade serous carcinoma[J].Gynecol Oncol,2013,128:371-376.
• [6]Singer G,Oldt R 3rd,Cohen Y,et al.Mutations in BRAF and KRAS characterize the development of low-grade ovarian serous carcinoma[J].J Natl Cancer Inst,2003,95:484-486.
• [7]Jones S,Wang TL,Kurman RJ,et al.Low-grade serous carcinomas of the ovary contain very few point mutations[J].J Pathol,2012,226:413-420.
• [8]Vang R,Shih Ie M,Kurman RJ.Ovarian low-grade and high-grade serous carcinoma:pathogenesis,clinicopathologic and molecular biologic features,and diagnostic problems[J].Adv Anat Pathol,2009,16:267-282.
• [9]Kurman RJ,Shih Ie M.The origin and pathogenesis of epithelial ovarian cancer:a proposed unifying theory[J].Am J Surg Pathol,2010,34:433-443.
• [10]Kuo KT,Guan B,Feng Y,et al.Analysis of DNA copy number alterations in ovarian serous tumors identifies new molecular genetic changes in low-grade and high-grade carcinomas[J].Cancer Res,2009,69:4036-4042.
• [11]Hannibal CG,Vang R,Junge J,et al.A nationwide study of serous“borderline”ovarian tumors in Denmark 1978-2002:Centralized pathology review and overall survival compared with the general population[J].Gynecol Oncol,2014,134:267-273.
• [12]Roma A,Malpica A,Deavers M,et al.Ovarian serous borderline tumors with a predominant micropapillary pattern are aggresslve neoplasms with an increased risk of low grade serous carcinoma[J].Modern Pathol,2008,21:221A.
• [13]National Comprehensive Cancer Network.NCCN Clinical Practice Guidelines in Oncology(NCCN Guideline),Ovarian Cancer,Version 2.2015[EB/OL].[2015-07-10].http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.