核异型性是诊断原发性卵巢纤维肉瘤的必要因素：病例报告及文献复习。

Gynecology and Obstetrics Department, Tianjin Third Central Hospital, Tianjin, China,

Gynecology and Obstetrics Department, Tianjin Third Central Hospital, Tianjin, China.

Gynecol Obstet Invest. 2020;85(5):437-445. doi: 10.1159/000510875. Epub 2020 Oct 2.

INTRODUCTION

Primary ovarian fibrosarcoma is a rare malignant tumor with few case reports. The current opinion in diagnosis preferring mitotic activity was questioned as there is a large amount of heterogeneity in prognosis between cases. We report a case of primary ovarian fibrosarcoma, and a literature review was performed according to the latest diagnostic trends. This is the first study to review the prognostic factors of primary ovarian fibrosarcoma according to the latest trend in diagnosis.

CASE PRESENTATION

A 50-year-old woman with primary ovarian fibrosarcoma is reported. The patient was admitted to the hospital due to increasing abdominal girth. Physical examination and CT scan showed a giant mass from the suprapubic area to the xiphoid region which filled her entire abdominopelvic cavity. Frozen sections were performed during an operation to resect, and the pathology report indicated a high degree of malignancy. Because of the degree of malignancy, a bilateral salpingo-oophorectomy and omentectomy were performed. Histopathological examination and immunohistochemical staining confirmed the diagnosis of primary ovarian fibrosarcoma. During the operation, the tumor ruptured, which placed the patient in a FIGO stage IC1. After surgery, the patient received 6 courses of combination chemotherapy, consisting of etoposide, bleomycin, and cisplatin. The patient has been free from disease without evidence of recurrence at 5 months after the initial diagnosis.

CONCLUSIONS

Herein we report a case of primary ovarian fibrosarcoma and reviewed all published cases in English. Following the latest trend of diagnosis, multiple prognostic factors were used to determine survival prognosis. These included nuclear atypia, FIGO stage, mitotic counts, treatment methods, and tumor size. Only nuclear atypia was found to be associated with patient prognosis (p < 0.05). FIGO stage (p = 0.383), mitotic count per 10 hpfs (p = 0.155), treatment methods (p = 0.185), and tumor size (p = 0.972) were not found to be associated with survival prognosis. Nuclear atypia was an important factor in prognosis of patients. Using surgery with adjuvant medical treatment was inconclusive regarding patient survival.

简介

原发性卵巢纤维肉瘤是一种罕见的恶性肿瘤，仅有少数病例报告。目前在诊断中倾向于有丝分裂活性的观点受到质疑，因为病例之间的预后存在很大的异质性。我们报告了一例原发性卵巢纤维肉瘤，并根据最新的诊断趋势进行了文献复习。这是第一项根据最新诊断趋势综述原发性卵巢纤维肉瘤预后因素的研究。

病例介绍

报告了一名 50 岁女性原发性卵巢纤维肉瘤患者。患者因腹部周长增加而入院。体格检查和 CT 扫描显示耻骨区至上腹部的巨大肿块填满整个腹盆腔。在手术切除过程中进行了冷冻切片，病理报告显示高度恶性。由于恶性程度高，进行了双侧输卵管卵巢切除术和网膜切除术。组织病理学检查和免疫组织化学染色证实了原发性卵巢纤维肉瘤的诊断。手术过程中肿瘤破裂，患者处于 FIGO 分期 IC1 期。手术后，患者接受了 6 个疗程的联合化疗，包括依托泊苷、博来霉素和顺铂。患者在初始诊断后 5 个月无疾病且无复发迹象。

结论

在此，我们报告了一例原发性卵巢纤维肉瘤病例，并回顾了所有用英文发表的病例。根据最新的诊断趋势，使用了多个预后因素来确定生存预后。这些因素包括核异型性、FIGO 分期、有丝分裂计数、治疗方法和肿瘤大小。只有核异型性与患者预后相关（p<0.05）。FIGO 分期（p=0.383）、每 10 高倍镜视野的有丝分裂计数（p=0.155）、治疗方法（p=0.185）和肿瘤大小（p=0.972）与生存预后无关。核异型性是影响患者预后的重要因素。手术联合辅助治疗对患者生存的影响尚无定论。