Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitari Dexeus, Barcelona, Spain; the Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy; and the Department of Obstetrics and Gynaecology, Medical School, University of Navarra, Pamplona, Spain.
Obstet Gynecol. 2017 Dec;130(6):1244-1250. doi: 10.1097/AOG.0000000000002327.
To assess the natural history of ultrasonographically diagnosed benign ovarian teratomas in asymptomatic women.
We conducted a retrospective observational cohort study of 408 women (mean age 36.6 years, range 14-81 years) diagnosed as having an ovarian teratoma by transvaginal ultrasonography (except eight who only had a transabdominal study done) between January 2003 and December 2013 at a single tertiary care institution. Six hundred thirteen women were diagnosed with ovarian teratoma of whom 205 were promptly treated surgically, leaving 408 patients followed conservatively with follow-up scans at 3 and 6 months from diagnosis and then yearly. The ultrasonographic diagnosis of a benign ovarian teratoma required at least one of the following features: a cystic mass with mixed echogenicity, thick band-like echoes, a fat-fluid level, or echogenic tubercle with posterior shadowing. Clinical, ultrasonographic, and histologic data (in case of surgery) were retrieved for analysis.
During follow-up, 130 of 408 (31.8%) women underwent surgery. The main reason for surgery was the physician's recommendation according to our protocol (n=115). One patient had adnexal torsion. Most surgeries (112/130 [86.2%]) were performed within the first 5 years after diagnosis. The remainder (278/408) is still being followed (median time 45.6 months, range 6-147 months). The vast majority of these lesions had no change and women remain asymptomatic. Histologic diagnosis of tumors removed surgically revealed a benign ovarian teratoma in 103 of 130 (79.2%) of the women. There were two borderline tumors, four endometriomas, three fibromas, seven serous cysts, two mucinous cysts, two stroma ovarii, seven other benign, and no case of malignant tumor.
Our results demonstrate that expectant management might be a reasonable option for managing asymptomatic women who receive a ultrasonographic diagnosis of a benign ovarian teratoma. The risk of undergoing surgery for this lesion decreases significantly after 5 years to follow-up. With careful observation, the risk of missing a diagnosis of malignancy is low.
评估无症状女性经阴道超声诊断为良性卵巢畸胎瘤的自然病程。
我们对 2003 年 1 月至 2013 年 12 月在一家三级保健机构经阴道超声（除 8 例仅行经腹检查外）诊断为卵巢畸胎瘤的 408 例女性（平均年龄 36.6 岁，范围 14-81 岁）进行了回顾性观察队列研究。613 例女性被诊断为卵巢畸胎瘤，其中 205 例及时接受了手术治疗，其余 408 例接受了保守治疗，在诊断后 3 个月和 6 个月以及每年进行随访扫描。经阴道超声诊断良性卵巢畸胎瘤需要至少具备以下特征之一：囊性肿块伴混合回声、厚带状回声、脂肪-液体水平或回声性结节伴后方阴影。检索了临床、超声和组织学数据（在手术情况下）以进行分析。
在随访期间，408 例女性中有 130 例（31.8%）接受了手术。手术的主要原因是根据我们的方案医生的建议（n=115）。1 例患者发生附件扭转。大多数手术（112/130 [86.2%]）在诊断后 5 年内进行。其余 278 例（408 例）仍在随访中（中位数时间 45.6 个月，范围 6-147 个月）。这些病变绝大多数没有变化，女性仍无症状。手术切除的肿瘤组织学诊断显示 130 例女性中有 103 例（79.2%）为良性卵巢畸胎瘤。有 2 例交界性肿瘤、4 例子宫内膜异位症、3 例纤维瘤、7 例浆液性囊肿、2 例黏液性囊肿、2 例卵巢基质、7 例其他良性肿瘤和无恶性肿瘤。
我们的结果表明，对于接受经阴道超声诊断为良性卵巢畸胎瘤的无症状女性，期待治疗可能是一种合理的选择。该病变在随访 5 年后进行手术的风险显著降低。通过仔细观察，漏诊恶性肿瘤的风险较低。
