Kobayashi F, Monma C, Nanbu K, Konishi I, Sagawa N, Mori T
Department of Gynecology and Obstetrics, Faculty of Medicine, Kyoto University, Japan.
Gynecol Oncol. 1996 Aug;62(2):309-13. doi: 10.1006/gyno.1996.0233.
The complete clinical course of a case of ovarian clear cell carcinoma expressing luteinizing hormone (LH)/human chorionic gonadotropin (hCG) receptor arising from endometriosis in a pregnant woman is presented. A 31-year-old woman visited a private clinic in May 1993 for screening tests for infertility. Transvaginal ultrasonography revealed no abnormal findings in the uterus or ovaries. Her menstrual cycle was regular; however, a slight luteal insufficiency was noted. She had been treated with clomiphene, and soon became pregnant. She was diagnosed to be at 5 weeks gestation in June, and at the same time, an ovarian tumor with the diameter of 5 cm was identified. Since the tumor had grown rapidly and was 9 cm in diameter 1 week later, she was referred to our hospital. When she was admitted to our hospital at 9 weeks gestation, the tumor diameter was 14 cm and we found the solid portion within the ovarian tumor. The levels of the tumor markers CA125 and CA19-9 were 106 and 51 U/ml, respectively. The crown-rump length of the fetus (24 mm) was compatible with the gestational age, and fetal heartbeat was confirmed. Under the diagnosis of ovarian carcinoma, right salpingo-oophorectomy was performed at 10 weeks of gestation. Postoperative histological examination revealed a clear cell carcinoma and endometriosis of the right ovary. Immunohistochemically, the clear cell carcinoma stained positively for LH/hCG receptors and estrogen receptors, but not progesterone receptor. No malignant cells were detected by ascitic cytology. Exploratory specimens obtained at the time of operation from the left ovary and pelvic lymph nodes exhibited no malignant cells. Based on these findings, the pregnancy was allowed to proceed, and she delivered a 3010-g male baby at 39 weeks of gestation. She had no signs of recurrence for 2 years after the operation.
本文报告了一例妊娠合并卵巢透明细胞癌的完整临床过程，该肿瘤起源于子宫内膜异位症且表达促黄体生成素（LH）/人绒毛膜促性腺激素（hCG）受体。一名31岁女性于1993年5月前往一家私人诊所进行不孕症筛查。经阴道超声检查显示子宫和卵巢未发现异常。她的月经周期规律，但存在轻微黄体功能不全。她接受了氯米芬治疗，不久后怀孕。6月时她被诊断为妊娠5周，同时发现一个直径5厘米的卵巢肿瘤。由于肿瘤生长迅速，1周后直径达9厘米，她被转诊至我院。妊娠9周入院时，肿瘤直径为14厘米，我们在卵巢肿瘤内发现了实性部分。肿瘤标志物CA125和CA19-9水平分别为106和51 U/ml。胎儿头臀长（24毫米）与孕周相符，且确认有胎心。在诊断为卵巢癌后，于妊娠10周时行右侧输卵管卵巢切除术。术后组织学检查显示右侧卵巢为透明细胞癌和子宫内膜异位症。免疫组化结果显示，透明细胞癌对LH/hCG受体和雌激素受体呈阳性染色，但对孕激素受体呈阴性染色。腹水细胞学检查未发现恶性细胞。手术时取自左侧卵巢和盆腔淋巴结的探查标本也未发现恶性细胞。基于这些发现，允许妊娠继续，她在妊娠39周时分娩了一名体重3010克的男婴。术后2年她没有复发迹象。
