Genadry R, Poliakoff S, Rotmensch J, Rosenshein N B, Parmley T H, Woodruff J D
Obstet Gynecol. 1981 Dec;58(6):730-4.
Subsequent to the recognition of the intraperitoneal tumors of low malignant potential, clinicians have repeatedly faced the ambiguities inherent in a disease that seems aggressive on the basis of its wide distribution in the peritoneal cavity but benign on the basis of its histopathology and clinical course. Whereas the occasional case has been associated with extensive local reaction and ascites, except for a rare exception these tumors result in prolonged survival and in an absence of extraabdominal extension. The current review of 154 cases followed from 2 to 40 years, performed in an attempt to understand this perplexing disease, leads to the following conclusions: 1) Whereas frequently beginning on the ovary and showing a predilection for the pelvis, there are examples of widely disseminated peritoneal disease with minimal, if any, ovarian involvement; 2) the outcome without adjunctive therapy is excellent and thus such therapy is contraindicated in view of the death of only 2 of the 154 patients with disease, 1 of whom had had adjunctive intraperitoneal isotope therapy; and 3) this disease is best understood as a diffuse primary peritoneal tumor probably developing on the basis of irritating agents' reaching the abdominal cavity from the lower genital canal, a process similar to that proposed for the genesis of endometriosis. Such a low-grade primary in situ tumor that may involve the entire peritoneal cavity is compatible with prolonged survival.
在认识到具有低恶性潜能的腹膜内肿瘤后，临床医生反复面临一种疾病固有的模糊性，这种疾病基于其在腹膜腔广泛分布看似具有侵袭性，但基于其组织病理学和临床病程却是良性的。尽管偶尔有病例伴有广泛的局部反应和腹水，但除极少数例外，这些肿瘤导致患者长期存活且无腹外转移。目前对154例患者进行了为期2至40年的随访，试图了解这种令人困惑的疾病，得出以下结论：1）虽然这种疾病常起源于卵巢且好发于盆腔，但也有广泛播散至腹膜的病例，卵巢受累极少甚至没有；2）未接受辅助治疗的患者预后良好，鉴于154例患者中仅2例死亡，其中1例接受过辅助性腹膜内同位素治疗，因此这种辅助治疗是禁忌的；3）这种疾病最好理解为一种弥漫性原发性腹膜肿瘤，可能是由于刺激物从下生殖道进入腹腔所致，这一过程类似于子宫内膜异位症的发病机制。这样一种可能累及整个腹膜腔的低级别原位肿瘤与长期存活是相符的。
