Ovarian nongestational choriocarcinoma mixed with various epithelial malignancies in association with endometriosis
Ovarian nongestational choriocarcinoma mixed with various epithelial malignancies in association with endometriosis
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DOI：
10.1016/j.ygyno.2006.01.001
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发表时间：
2006-07-01
影响因子：
4.7
通讯作者：
Murakami, Masaru
中科院分区：
文献类型：
--
作者：
Hirabayashi, Kenichi;Yasuda, Masanori;Murakami, Masaru
背景与子宫绒毛膜癌相比，卵巢绒毛膜癌很少发生。此外，卵巢癌与表面上皮性肿瘤并存是非常罕见的。一位50岁的绝经后妇女，妊娠0，被收住到我们的医院腹痛和腹胀，由于一个复杂的卵巢肿瘤。实验室检查显示血清CA 125、神经元特异性烯醇化酶（NSE）和hCG β亚基C端肽（hCG β CTP）水平升高。行腹式全子宫切除术、右侧输卵管卵巢切除术和淋巴结清扫术。右侧卵巢显示一个囊性肿瘤，有两个实体部分：较大部分，类囊腺癌和小细胞癌;较小部分，主要是CC和局灶性透明细胞腺癌。CA 125在首次手术后迅速下降，但hCG-β-CTP水平在死亡前的最后几个月内反复出现明显波动，NSE突然升高。患者于首次手术后10个月死亡。只有四例卵巢非妊娠性CC并存于表面上皮性肿瘤的报告。这是第一次报告的混合CC与三个上皮恶性肿瘤的情况下。我们认为，类胶质细胞腺癌和透明细胞腺癌出现在不同的网站与子宫内膜异位症的致瘤因素，前者可能已被去分化为小细胞癌和后者CC。CC与小细胞癌的共存被认为是导致预后不良的相对化疗耐药的原因。(c)2006年爱思唯尔公司所有的战斗保留。
Background. Ovarian choriocarcinoma (CC) is rarely encountered as compared to uterine CC. Furthermore, ovarian CC coexisting with surface epithelial tumor is very rare.Case. A 50-year-old postmenopausal woman, gravida 0, was admitted to our hospital with abdominal pain and distention due to a complex ovarian tumor. The laboratory data showed high serum level of CA125, neuron specific enolase (NSE), and hCG beta-subunit C-terminal peptide (hCG-beta-CTP). Total abdominal hysterectomy, right salpingoophorectomy, and lymph node dissection were performed. The right ovary revealed a cystic tumor with two solid parts: larger part, endometrioid adenocarcinoma and small cell carcinoma; smaller part, predominantly CC and focally clear cell adenocarcinoma. CA125 was rapidly decreased after first operation, but hCG-beta-CTP levels repeated distinctive fluctuations and NSE abruptly increased during the last few months before death. The patient died 10 months after the first operation.Conclusion. Only four cases of ovarian nongestational CC coexisting with surface epithelial tumor have been reported. This is the first reported case of admixture of CC with three epithelial malignancies. We assume that endometrioid and clear cell adenocarcinomas arose at different sites as tumorigenic factors in association with endometriosis, and the former may have been dedifferentiated into small cell carcinoma and the latter to CC. Coexistence of CC with small cell carcinoma is considered to be responsible for relative chemoresistance leading to poor prognosis. (c) 2006 Elsevier Inc. All fights reserved.