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卵巢中-低分化支持-间质细胞瘤一例并文献复习

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中、低分化或二者成分混合的支持-间质细胞瘤(Sertoli-Leydig cell tumor,SLCT)具有恶性倾向。报告1例18岁年轻女性以闭经为首发表现,随后10个月内逐渐出现乳房萎缩的去女性化表现,以及喉结突出、口唇胡须生长、声音低沉和阴蒂肥大的男性化体征。患者6年前有甲状腺结节手术史,排除甲状腺功能异常后行开腹探查术,术中见左侧卵巢直径约10 cm的巨大囊实性肿瘤,行保留生育功能的左侧附件切除术+右侧卵巢活检术+双侧结肠旁沟腹膜活检术+大网膜活检术,术后病理确诊为卵巢中-低分化SLCT。随后患者经过4个周期紫杉醇脂质体和卡铂方案的化疗后恢复良好,且成功生育。对于育龄期女性出现去女性化甚至男性化表现,应当考虑卵巢SLCT的可能,按照肿瘤分级个体化选择保留生育功能手术和根治手术,术后复发风险高的患者及时辅以化疗,降低二次手术和死亡风险。
Modium-Low Differentiation Sertoli-Leydig Cell Tumor of the Ovary:A Case Report and Literature Review
The medium-low differentiation Sertoli-Leydig cell tumor(SLCT)has the tendency to become a malignant tumor.A case of SLCT in an 18-year-old young woman was reported.Amenorrhea was the first symptom.Within then 10 months,she gradually developed defeminizing symptoms of breast atrophy,as well as signs of virilization such as protruding Adam's apple,growth of lip beard,deep voice,and clitoral hypertrophy.She had a medical history of thyroid nodule surgery 6 years ago,and the function of thyroid was normal.A large cystic-solid tumor of the left ovary was found under the laparotomic exploration,approximately 10 cm in diameter.Operation was performed,including left adnexectomy,right ovary biopsy,bilateral para-colonic sulcus peritoneal biopsy and greater omentum biopsy.The postoperative pathological diagnosis indicated the medium-low differentiation of SLCT.The patient subsequently recovered well after 4 cycles of chemotherapy with paclitaxel liposome and carboplatin,and was successful childbirth.For women of childbearing age who exhibit de feminization or even masculinization,the possibility of ovarian SLCT should be considered.Fertility preserving surgery and radical surgery should be individualized according to the tumor grading.Patients with high risk of postoperative recurrence should receive timely chemotherapy to reduce the risk of secondary surgery and death.

Sertoli-Leydig cell tumorOvarian neoplasmsVirilismAntineoplastic combined chemotherapy protocolsFertility preservation

刘书杰、李明泽、张海燕

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250117 济南,山东第一医科大学(山东省医学科学院)

滨州医学院

临沂市人民医院妇科

Sertoli-Leydig细胞瘤 卵巢肿瘤 男性化 抗肿瘤联合化疗方案 保留生育能力

2024

国际生殖健康/计划生育杂志
天津市医学科学技术信息研究所

国际生殖健康/计划生育杂志

CSTPCD
影响因子:0.694
ISSN:1674-1889
年,卷(期):2024.43(3)
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