Iwata Kazuma, Hamaguchi Daisuke, Mizota Takamitsu, Matsuoka Yuki, Miura Kiyonori
Department of Obstetrics and Gynecology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JPN.
Department of Obstetrics and Gynecology, Isahaya General Hospital, Isahaya, JPN.
Cureus. 2025 Mar 28;17(3):e81381. doi: 10.7759/cureus.81381. eCollection 2025 Mar.
Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is associated with ovarian teratomas in approximately half of all cases. Surgical removal of these teratomas, combined with immunotherapy, results in rapid improvement in about half of patients. However, the remaining patients exhibit slower improvement and are at risk of severe complications. Additional surgeries may be considered for these patients. Since even microscopic teratomas can contribute to treatment resistance, complete removal of the remaining ovaries is often selected as a surgical approach. However, this approach results in loss of fertility. We report the case of a 28-year-old woman with bilateral ovarian teratomas and a refractory clinical course after initial treatment, including left salpingo-oophorectomy and right cystectomy. She underwent two additional surgeries, one for a residual teratoma and the other for a recurrent teratoma, both involving cystectomies aimed at preserving fertility. She was discharged home a year after admission and gave birth to a baby two years later. Our case is unique in that three surgeries were performed for an anti-NMDA receptor encephalitis patient with teratomas without loss of fertility, and it documents the reproductive outcome of the patient.
抗N-甲基-D-天冬氨酸（NMDA）受体脑炎约半数病例与卵巢畸胎瘤相关。手术切除这些畸胎瘤并联合免疫治疗，约半数患者病情可迅速改善。然而，其余患者病情改善较慢且有发生严重并发症的风险。对于这些患者可考虑再次手术。由于即使是微小的畸胎瘤也可能导致治疗抵抗，因此常选择完全切除剩余卵巢作为手术方式。然而，这种方法会导致生育能力丧失。我们报告一例28岁女性，患有双侧卵巢畸胎瘤，初始治疗（包括左侧输卵管卵巢切除术和右侧囊肿切除术）后临床病程难治。她又接受了两次手术，一次针对残留畸胎瘤，另一次针对复发性畸胎瘤，两次手术均为旨在保留生育能力的囊肿切除术。她入院一年后出院，两年后生下一个婴儿。我们的病例独特之处在于，为一名患有畸胎瘤的抗NMDA受体脑炎患者进行了三次手术，且未丧失生育能力，并记录了该患者的生殖结局。
