巨大卵巢无性细胞瘤双侧发病一例

A Case of Bilateral Massive Ovarian Dysgerminoma

摘要: 无性细胞瘤是一种和精原细胞同源的卵巢恶性生殖细胞肿瘤(MOGCT)，通常发病年龄较年轻，本文通过阐述巨大肿块手术方式决策及术后辅助化疗的治疗方案的选择，对于年轻女性患者的生育力保护及延长患者生存期治疗方案提供参考依据。报告1例17岁青春期女性卵巢无性细胞瘤病例，患者因左腹持续性疼痛就诊于吉首大学第一附属医院妇科，腹部体查扪及肿块上缘达剑突、两侧达腋中线，质中，边界尚清，活动度可，CA125、β-HCG明显升高，CA199轻度升高，剖腹探查术中冰冻病例考虑双侧冰冰均卵巢无性细胞瘤，行左侧附件切除 + 右侧卵巢囊肿剥除术，术中切除左侧附件重量4.3 kg，术后EP方案依托泊苷(etoposide)、顺铂(cisplatin)方案化疗同时给予亮丙瑞林保护卵巢功能治疗。现已随访17个月，目前患儿生存状况良好，月经规律，未发现肿瘤复发或转移。

Abstract: Dysgerminoma is a malignant ovarian germcell tumor (MOGCT) that originates from primordial germ cells and typically occurs in young patients. This article discusses the decision-making process for surgical management of a massive tumor and the selection of postoperative adjuvant chemotherapy regimens, providing reference for fertility preservation and extending survival in young female patients. We report a case of a 17-year-old adolescent with ovarian dysgerminoma who presented with persistent left-abdominal pain and was admitted to the Gynecology Department of the First Affiliated Hospital of Jishou University. Physical examination revealed a palpable mass extending superiorly to the xiphoid process and laterally to the mid-axillary lines; the mass was of medium consistency, with relatively clear borders and good mobility. Serum markers showed markedly elevated CA-125 and β-hCG, with mildly increased CA19-9. Intra-operative frozen section suggested bilateral ovarian dysgerminoma. The patient underwent left salpingo-oophorectomy combined with right ovarian cystectomy; the left adnexal specimen weighed 4.3 kg. Postoperatively, she received EP chemotherapy (etoposide +  cisplatin) together with GnRH-agonist (leuprolide) for ovarian function protection. After 17 months of follow-up, the patient remains in good condition, with regular menstruation and no evidence of tumor recurrence or metastasis.