妊娠合并卵巢幼年型颗粒细胞瘤破裂一例(1)
【摘要】妊娠合并卵巢幼年型颗粒细胞瘤破裂临床上少见。该文报道了1例足月妊娠合并卵巢幼年型颗粒细胞瘤破裂患者的诊治经过。该患者27岁，孕2产0，停经39+3周，因间断右下腹疼痛3 d、加重4 h入院，入院完善检查后行剖宫产术及剖腹探查术并分娩一健康男婴，术中在患者右侧卵巢可见一大小约80 cm×60 cm×70 cm、已破裂的肿物，术后病理回報符合幼年型颗粒细胞瘤，随后行保留生育能力的分期手术。术后予紫杉醇+顺铂方案化学治疗3个疗程，随访9个月，肿瘤未见复发。该例提示，足月妊娠已临产合并卵巢幼年型颗粒细胞瘤破裂诊断复杂，且术前、术中易误诊，治疗较为棘手，确诊需依赖术后病理及免疫组织化学染色检查。
【关键词】妊娠；先兆临产；卵巢肿瘤；颗粒细胞瘤
Threatened pregnancy complicated with rupture of ovarian juvenile granular cell tumor： a case report Chen Yang， Li Yang， Wu Fuju Department of Gynaecology and Obstetrics， the Second Hospital of Jilin University， Changchun 130041， China
Corresponding author， Wu Fuju， Email：fujuwu0052@sinacom
【Abstract】Pregnancy complicated with the rupture of ovarian juvenile granular cell tumor is rare in clinical practice In this article， the diagnosis and treatment of a fullterm pregnant women complicated with ovarian juvenile granular cell tumor rupture were reported The 27yearold patient (G2P0) was at 39+3 weeks of gestation She was hospitalized due to intermittent right lower abdominal pain for 3 d and aggravated for 4 h After comprehensive examinations， she underwent cesarean section and laparotomy for laboring a healthy boy Intraoperatively， a tumor of approximately 80 cm×60 cm×70 cm in size was detected in the right ovary Postoperative pathological examination revealed the diagnosis of juvenile granular cell tumors Subsequently， the patient underwent fertilitypreserving staging surgery She received 3 courses of postoperative chemotherapy (paclitaxel plus cisplatin regimen) and was followed up for 9 months No recurrent tumor was observed This case prompts that the diagnosis of fullterm pregnancy complicated with the rupture of ovarian juvenile granular cell tumor is complicated， which is likely to make a misdiagnosis before and during surgery The treatment of this disease is challenging The diagnosis can be validated by postoperative pathological examination and immunohistochemical staining
【Key words】Pregnancy； Threatened labor； Ovarian neoplasm； Granular cell tumor
卵巢肿瘤在妇科肿瘤中较为常见，但妊娠合并卵巢恶性肿瘤在临床上较少见，占妊娠合并恶性肿瘤的3%～6%。近年来妊娠合并卵巢恶性肿瘤的发病率明显升高，其发病率居妊娠合并生殖道恶性肿瘤的第2位[13]。颗粒细胞瘤(GCT)是罕见的恶性性索间质肿瘤，仅占所有卵巢恶性肿瘤的1%～2%，根据组织学类型发现分为成人型GCT(AGCT，95%)和幼年型GCT(JGCT，5%)[45]。妊娠合并JGCT极其罕见，目前类似病例多为单纯病例回顾，并未对类似病例的诊治进行总结归纳或提出问题。本文回顾性分析1例足月妊娠先兆临产合并JGCT破裂患者的诊治经过，并结合相关文献资料进行总结分析，旨在为相关疾病的诊治提供参考。
病例资料
一、 病史及体格检查
患者女，27岁。因间断右下腹疼痛3 d，加重4 h于2017年4月30日入院。患者停经39+3周，在3 d前出现间断性右下腹疼痛，尚可忍受，4 h前出现疼痛加重，难以忍受。其在怀孕期间均行规律产检，未见明显异常。末次月经日期不详。孕前月经不规律，月经量中等，色暗红，偶有痛经及血块，无异常阴道流血史，白带无异常。孕2产0，6年前行人流术1次。按孕早期推算预产期为2017年5月4日。配偶体健。既往史、个人史无特殊。, http://www.100md.com(陈洋 李阳 吴富菊)
【关键词】妊娠；先兆临产；卵巢肿瘤；颗粒细胞瘤
Threatened pregnancy complicated with rupture of ovarian juvenile granular cell tumor： a case report Chen Yang， Li Yang， Wu Fuju Department of Gynaecology and Obstetrics， the Second Hospital of Jilin University， Changchun 130041， China
Corresponding author， Wu Fuju， Email：fujuwu0052@sinacom
【Abstract】Pregnancy complicated with the rupture of ovarian juvenile granular cell tumor is rare in clinical practice In this article， the diagnosis and treatment of a fullterm pregnant women complicated with ovarian juvenile granular cell tumor rupture were reported The 27yearold patient (G2P0) was at 39+3 weeks of gestation She was hospitalized due to intermittent right lower abdominal pain for 3 d and aggravated for 4 h After comprehensive examinations， she underwent cesarean section and laparotomy for laboring a healthy boy Intraoperatively， a tumor of approximately 80 cm×60 cm×70 cm in size was detected in the right ovary Postoperative pathological examination revealed the diagnosis of juvenile granular cell tumors Subsequently， the patient underwent fertilitypreserving staging surgery She received 3 courses of postoperative chemotherapy (paclitaxel plus cisplatin regimen) and was followed up for 9 months No recurrent tumor was observed This case prompts that the diagnosis of fullterm pregnancy complicated with the rupture of ovarian juvenile granular cell tumor is complicated， which is likely to make a misdiagnosis before and during surgery The treatment of this disease is challenging The diagnosis can be validated by postoperative pathological examination and immunohistochemical staining
【Key words】Pregnancy； Threatened labor； Ovarian neoplasm； Granular cell tumor
卵巢肿瘤在妇科肿瘤中较为常见，但妊娠合并卵巢恶性肿瘤在临床上较少见，占妊娠合并恶性肿瘤的3%～6%。近年来妊娠合并卵巢恶性肿瘤的发病率明显升高，其发病率居妊娠合并生殖道恶性肿瘤的第2位[13]。颗粒细胞瘤(GCT)是罕见的恶性性索间质肿瘤，仅占所有卵巢恶性肿瘤的1%～2%，根据组织学类型发现分为成人型GCT(AGCT，95%)和幼年型GCT(JGCT，5%)[45]。妊娠合并JGCT极其罕见，目前类似病例多为单纯病例回顾，并未对类似病例的诊治进行总结归纳或提出问题。本文回顾性分析1例足月妊娠先兆临产合并JGCT破裂患者的诊治经过，并结合相关文献资料进行总结分析，旨在为相关疾病的诊治提供参考。
病例资料
一、 病史及体格检查
患者女，27岁。因间断右下腹疼痛3 d，加重4 h于2017年4月30日入院。患者停经39+3周，在3 d前出现间断性右下腹疼痛，尚可忍受，4 h前出现疼痛加重，难以忍受。其在怀孕期间均行规律产检，未见明显异常。末次月经日期不详。孕前月经不规律，月经量中等，色暗红，偶有痛经及血块，无异常阴道流血史，白带无异常。孕2产0，6年前行人流术1次。按孕早期推算预产期为2017年5月4日。配偶体健。既往史、个人史无特殊。, http://www.100md.com(陈洋 李阳 吴富菊)
参见：首页 > 医学版 > 医学知识 > 生殖系统 > 女性生殖系统 > 卵巢