Human chorionic gonadotropin elevation in gliomatosis peritonei complicated with immature teratoma: A case report and review of the literature.
Human chorionic gonadotropin elevation in gliomatosis peritonei complicated with immature teratoma: A case report and review of the literature.
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腹膜胶质瘤病并发未成熟畸胎瘤人绒毛膜促性腺激素升高一例报告并文献复习
DOI：
10.1097/md.0000000000031305
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发表时间：
2022-10-28
期刊：
影响因子：
1.6
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中科院分区：
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理论基础：腹膜胶质瘤病(GP)是指在内脏和壁层腹膜表面种植胶质组织，常与未成熟畸胎瘤相关。这是一种罕见的疾病，其发病机制尚不完全清楚。此外，未成熟畸胎瘤和成熟畸胎瘤的放射学表现难以区分，加上有限的病理标本，使得大多数病例很难做出准确的诊断。更重要的是，患者还面临手术后复发的风险。本文旨在描述GP合并未成熟畸胎瘤的诊断和治疗过程。患者关注：患者，38岁，女性，在腹腔镜下卵巢囊肿切除术后出现GP合并未成熟畸胎瘤。诊断：体检时，可触摸到15厘米长的盆腔肿块，活动能力差。肿瘤标记物显示α-胎儿蛋白和糖类抗原125适度升高。根据综合的术前评估，术后病理显示左侧卵巢未成熟畸胎瘤，合并腹膜神经胶质瘤。第二次手术三个月后，考虑到未成熟畸胎瘤可能复发，患者接受了第三次剖腹手术。但术后病理显示，盆腔病变中有成熟的畸胎瘤和成熟的胶质成分。干预措施和结果：患者在初次切除后又接受了2次手术切除和3个周期的博莱霉素、依托泊苷和顺铂方案化疗。她在手术后定期在门诊接受随访，到目前为止还没有盆腔复发的报告。教训：这一病例说明GP合并未成熟畸胎瘤的初步诊断是关键的，但对妇科医生和病理医生来说都具有很高的挑战性，应更多地关注“GP合并未成熟囊性畸胎瘤”患者，以避免不当的治疗。
Rationale: Gliomatosis peritonei (GP) refers to the implantation of glial tissue on the visceral and parietal peritoneal surface, often associated with immature teratoma. It is a rare condition and the pathogenesis is not fully understood. In addition, the indistinguishable radiological appearance of immature and mature teratomas, and limited pathology samples make an accurate diagnosis difficult in most cases. More importantly, patients are also at risk of recurrence after surgery. This report aims to describe the process of diagnosis and treatment of GP with immature teratoma. Patient concerns: The patient, a 38-year-old woman presented with GP complicated with immature teratoma after laparoscopic ovarian cyst excision. Diagnoses: On physical examination, a 15 cm-pelvic mass, with poor mobility, was palpated. And tumor marker demonstrated a moderate increase in α-fetoprotein and carbohydrate antigen 125. We suspected malignancy according to the comprehensive preoperative evaluation, the postoperative pathology revealed an immature teratoma of the left ovary and complicated with gliomatosis peritonei. Three months after the second surgery, possible recurrence of immature teratoma was considered and the patient underwent the third laparotomy. But the postoperative pathology indicated mature teratoma and mature glial components in the pelvic lesions. Interventions and outcome: The patient underwent 2 more surgical resections after the initial resection and 3 cycles of bleomycin, etoposide, and cisplatin regimen chemotherapy. She was regularly followed up in the outpatient after surgery, and no recurrence has been reported in the pelvic cavity till date. Lesson: The case illuminated that the primary diagnosis of GP complicated with immature teratoma is critical but highly challenging for both gynecologists and pathologists and more attention should be paid to “GP complicated with immature cystic teratoma” patients to avoid inappropriate treatment.