RESUMEN
OBJECTIVE: To investigate the operative treatment for first-treated patients with malignant ovarian germ cell tumors who need preservation of fertility. METHODS: The clinical data of 105 patients who were treated with fertility-sparing surgery in 11 hospitals from 1992 to 2010 were collected to evaluate the outcomes of different primary surgical operative procedures. All 105 cases were performed the surgeries that preserved fertility and divided into three groups according to the surgical approaches, comprehensive staging surgery group: 47 cases (44.8%) received comprehensive staging surgeries that including the ipsilateral oophorectomy + omentectomy + retropertoneal lymph node dissection ± appendectomy + multiple biopsies;oophorectomy group:45 cases (42.9%)received ipsilateral oophorectomy ± biopsy of contralateral ovary ± omentectomy;tumor resection group:13 cases (12.4%) received enucleation of the mass with preservation of the ovary. Differences were compared among the three groups of patients in the surgery-related indicators, complications, fertility and prognosis. RESULTS: (1) Surgery-related indicators:the average blood loss of the comprehensive staging surgery group, the oophorectomy group and the tumor resection group were 496, 104 and 253 ml, the mean operation time were 176, 114 and 122 minutes, respectively, and there were significant differences among three groups (P = 0.011, P = 0.000). (2) Complication:the surgical complication rates of the three groups were 17% (8/47), 0 and 1/13, with significant differences (P = 0.015). (3) Reproductive function status: the pregnancy rate and birth rate of the three groups were no significant differences (9/19 vs. 7/19 vs. 2/3, P = 0.515; 8/19 vs. 5/19 vs. 2/3, P = 0.636). (4) PROGNOSIS: the recurrence rate of the three groups were significant differences [13% (6/47) vs. 0 vs. 2/13, P = 0.013], but the death rate with no significant differences [6% (3/47) vs. 0 vs. 0, P = 0.129]; The five-year survival rate of three different groups were 89%, 100% and 100% (P > 0.05), while disease free survival rate were 85%, 100% and 83% (P < 0.05), respectively. CONCLUSIONS: Compared with comprehensive staging surgery, oophorectomy group have higher surgical security and satisfactory prognosis, considerable pregnancy rates and birth rate. The tumor resection security may be reliable, but the prognosis is poor.
Asunto(s)
Preservación de la Fertilidad , Neoplasias de Células Germinales y Embrionarias/cirugía , Neoplasias Ováricas/cirugía , Ovariectomía/métodos , Adolescente , Adulto , Biopsia con Aguja , Quimioterapia Adyuvante , Niño , Preescolar , Supervivencia sin Enfermedad , Femenino , Procedimientos Quirúrgicos Ginecológicos/métodos , Humanos , Escisión del Ganglio Linfático , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Neoplasias de Células Germinales y Embrionarias/mortalidad , Neoplasias de Células Germinales y Embrionarias/patología , Epiplón/patología , Epiplón/cirugía , Neoplasias Ováricas/mortalidad , Neoplasias Ováricas/patología , Embarazo , Índice de Embarazo , Estudios Retrospectivos , Tasa de Supervivencia , Adulto JovenRESUMEN
OBJECTIVE: To identify the potential neoplastic risk in gonadal development abnormality with Y chromosome. METHODS: Inquiries about the illness history were made. Lymphocyte chromosomal karyotype of peripheral blood was analyzed. Sex determining region Y gene and relative steroids and enzymes were detected. Gonadal site was examined through medical imaging. Gonadal excision was performed by laparotomy or laparoscopy. Pathological examinations were done on all of the specimens. RESULTS: Among 41 cases of androgen insensitive syndrome, spermatogenic cell neoplasm occurred in 1 patient, sertoli cell tumor in 2, and interstitial cell hyperplasia in 5. Among 14 cases of 17 alpha-hydroxylase deficiency (XY) syndrome, one was sertoli cell tumor, and one was sertoli cell hyperplasia. In 4 cases of XY pure gonadal dysgenesis, one was gonadoblastoma with dysgerminoma. One of 16 cases of XO/XY gonadal dysgenesis was spermatogenic cell neoplasm with agenda cell tumor. Four cases of testes degeneration were all with dysgenetic testes. All of the gonadoblastoma and germ-cell tumor were located in the pelvis. Tumors occurred mostly during 15 years of age to 32 years. CONCLUSIONS: The gonads of XY pure gonadal dysgenesis has high risks of gonadoblastoma and germ-cell tumor. The older the onset age after puberty, the higher the malignancy risk is. Once diagnosed, bilateral gonads should be excised as soon as possible.
Asunto(s)
Síndrome de Resistencia Androgénica/genética , Cromosomas Humanos Y/genética , Disgenesia Gonadal 46 XY/genética , Gonadoblastoma/genética , Neoplasias Ováricas/genética , Adolescente , Adulto , Factores de Edad , Síndrome de Resistencia Androgénica/complicaciones , Síndrome de Resistencia Androgénica/cirugía , Niño , Preescolar , Femenino , Disgenesia Gonadal/complicaciones , Disgenesia Gonadal/genética , Disgenesia Gonadal/cirugía , Disgenesia Gonadal 46 XY/complicaciones , Disgenesia Gonadal 46 XY/cirugía , Gonadoblastoma/etiología , Gonadoblastoma/prevención & control , Humanos , Cariotipificación , Masculino , Neoplasias Ováricas/etiología , Neoplasias Ováricas/prevención & control , Factores de Riesgo , Aberraciones Cromosómicas Sexuales , Adulto JovenRESUMEN
OBJECTIVE: To investigate the efficiency of positron emission tomography (PET) with (fluorine-18)-2-deoxyglucose ((18)FDG) in diagnosis of recurrent ovarian cancer. METHODS: (18)FDG-PET scanning and computerized tomography (CT) were performed on 31 patients 35 times, who were clinically free of disease after optimal cytoreductive surgery and first-line chemotherapy. Twenty-two patients were confirmed pathologically after second-look or re-debulking operation and the others were followed up by many methods (ultrasonography, CA(125) and pelvic examination combined), evaluating the role of PET and CT in the diagnosis of recurrent ovarian cancer. RESULTS: (1) PET demonstrated recurrent sites through increased (18)FDG uptake. In 35 times, PET showed 1 false-negative and 1 false-positive cases. (2) The sensitivity of (18)FDG-PET is 96.3%, and CT is 70.4%. There was significant difference between two groups (P < 0.05). CONCLUSION: PET is more sensitive in diagnosing recurrent ovarian cancer than CT, so it improve early diagnosis in recurrent ovarian cancer.