Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy Of Medical Sciences & Peking Union Medical College, People's Republic of China.
Gynecol Oncol. 2012 May;125(2):358-61. doi: 10.1016/j.ygyno.2011.12.430. Epub 2011 Dec 14.
Six cases of endodermal sinus tumor (EST) of the vagina were reported focusing on the results of conservative treatment and outcome of long-term follow up.
We reviewed a cohort of six cases with EST of the vagina diagnosed and treated in our hospital. CT scan, detection of serum AFP level, examination under anesthesia and biopsy were performed before and after treatment to evaluate the tumor status. The diagnoses were confirmed by pathological and imaging findings. All patients were treated with bleomycin, etoposide and cisplatin (BEP) combination chemotherapy alone. Complete remission (CR) includes the normal level of serum AFP, no tumor detected by CT scan and the negative result of pathology. Long-term follow up was carried out according to our regulation.
The mean onset age was 18.2 months. The average tumor size was 4.5 cm. Serum AFP level was markedly elevated before treatment and decreased dramatically after chemotherapy and drop to the normal level after two to three courses of chemotherapy (average 2.5 courses). The patients received averagely six courses of chemotherapy and all the six patients obtained CR. The mean follow-up time is 75.5 months and there was no evidence of recurrent disease.
The result of this conservative treatment for EST of the vagina is excellent. BEP chemotherapy without surgery should be considered as a good choice of treatment. Close follow up with serial determinations of serum AFP level together with imaging tests and physical examination in the first two years of follow-up are recommended.
本研究报道了 6 例阴道内胚窦瘤（EST）病例，重点探讨了保守治疗的结果和长期随访的结局。
我们回顾性分析了在我院诊断和治疗的 6 例阴道 EST 患者的资料。所有患者在治疗前后均进行 CT 扫描、血清 AFP 水平检测、麻醉下检查和活检以评估肿瘤状态。通过病理和影像学检查来确诊。所有患者均单独接受博来霉素、依托泊苷和顺铂（BEP）联合化疗。完全缓解（CR）包括血清 AFP 水平正常、CT 扫描未检测到肿瘤以及病理结果阴性。按照我们的规定进行长期随访。
患者的平均发病年龄为 18.2 个月，平均肿瘤大小为 4.5cm。治疗前血清 AFP 水平显著升高，化疗后明显下降，在 2-3 个疗程化疗后降至正常水平（平均 2.5 个疗程）。所有患者接受平均 6 个疗程化疗，均获得 CR。平均随访时间为 75.5 个月，未见疾病复发。
阴道内胚窦瘤采用保守治疗的效果非常好。不进行手术，采用 BEP 化疗应作为一种治疗选择。建议在前 2 年的随访中，通过连续测定血清 AFP 水平，结合影像学检查和体格检查进行密切随访。
