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目的探讨卵巢交界性肿瘤(borderline ovarian tumor,BOT)及伴微浸或局灶癌变的临床特点、病理类型、癌变潜能以及对血清CA125的敏感性。方法对2005年1月至2006年12月在天津市中心妇产科医院住院手术,术后病理确诊为卵巢交界性肿瘤及伴微浸或局灶癌变的88例进行分析,依据组织学诊断结果分为单纯BOT、BOT伴微浸以及BOT伴局灶癌变3组。结果发病年龄16～72岁,平均40.7岁,三组发病年龄比较无统计学意义(P>0.05)。75.0%(66/88)无临床症状,83.0%(73/88)肿物直径≥6cm。病理类型以卵巢交界性浆液性囊腺瘤或乳头状囊腺瘤为主占60.2%(53/88),交界性黏液性囊腺瘤占31.8%(28/88),交界性混合性囊腺瘤占4.5%(4/88),其他占3.4%(3/88)。88例中30例伴微浸,16例伴局灶癌变。在局灶癌变组中交界性浆液性囊腺瘤占3/4。BOT发生局灶癌变者与卵巢交界性浆液性囊腺瘤有较大的相关性,交界性浆液性肿瘤局灶癌变发生率明显高于黏液性肿瘤(P<0.05)。检测血清CA12579例,43例高于正常值,交界性肿瘤伴局灶癌变者血清CA125阳性率为(13/15)86.7%,交界性肿瘤伴微浸者阳性率为(18/26)69.2%,单纯交界性肿瘤阳性率为(12/38)31.6%。伴微浸及局灶癌变者对CA125的敏感性高于单纯BOT,有统计学意义(P<0.05)。1例术后18个月复发,术前血清CA125检测值在正常范围,术后病理仍为卵巢交界性浆液性乳头状囊腺瘤。结论卵巢交界性肿瘤具有低度恶性潜能,CA125对单纯BOT不敏感,术前诊断困难。育龄女性应定期行超声检查有无卵巢肿物,结合血清CA125检测可对BOT伴微浸以及伴局灶癌变者做术前预测诊断,积极尽早手术治疗,以减少癌变风险。
Objective To investigate the clinical features, pathological type, carcinogenic potential and the sensitivity to serum CA125 of borderline ovarian tumor (BOT) and microleakage or focal canceration. Methods From January 2005 to December 2006 in Tianjin Center of Obstetrics and Gynecology Hospital surgery, postoperative pathological diagnosis of borderline ovarian cancer and with micro-immersion or focal cancer in 88 cases were analyzed based on histological findings Divided into simple BOT, BOT with micro-immersion and BOT with focal cancerous change 3 groups. Results The onset age ranged from 16 to 72 years (mean, 40.7 years). There was no significant difference in age of onset between the three groups (P> 0.05). 75.0% (66/88) no clinical symptoms, 83.0% (73/88) tumor diameter ≥ 6cm. Pathological type of serous cystadenoma or papillary cystadenoma mainly accounted for 60.2% (53/88), borderline mucinous cystadenoma accounted for 31.8% (28/88), junctional mixed cyst gland Tumors accounted for 4.5% (4/88), others accounted for 3.4% (3/88). In 88 cases, 30 cases with micro-immersion and 16 cases with focal canceration. The borderline serous cystadenocarcinoma accounted for 3/4 in the focal cancerous group. BOT focal carcinogenesis and borderline serous cystadenoma have a greater correlation, borderline serous tumor incidence was significantly higher than mucinous tumors (P <0.05). Serum CA12579 serum samples were detected in 43 cases, higher than normal value. The positive rate of serum CA125 in borderline tumors with focal cancerous lesions was 86.7% (13/15), and the positive rate of borderline tumors with micro-immersion was 69.2% , The positive rate of borderline tumor was (12/38) 31.6%. The sensitivity to CA125 in patients with microleakage and focal canceration was significantly higher than that in simple BOT (P <0.05). One patient relapsed 18 months after operation. The preoperative serum CA125 was in the normal range and the postoperative pathology was still borderline serous papillary cystadenoma. Conclusion The ovarian borderline tumor has a low malignant potential. CA125 is not sensitive to simple BOT, and it is difficult to diagnose preoperatively. Women of childbearing age should have ultrasound examination of ovarian masses on a regular basis. Combined with serum CA125 detection, preoperative diagnosis can be made on BOT with microleaching and focal cancerous patients, and aggressive surgical treatment as soon as possible to reduce the risk of cancer.