| Objective: With the aim of helping us diagnose and treat SCST in clinic,this study retrospectively analyzed the clinical manifestations,imaging features,histological features,treatment methods and prognosis of 257 sex cord stromal tumors patients treated in Tianjin medical university central hospital,and refer to the literatures published in foreign and domestic journals in the past decade.Methods: Analyze retrospectively the clinical data of patients diagnosed with sex cord stromal tumors treated in Tianjin medical university central hospital from January 1989 to June 2019.Collect prognosis of these patients by telephone follow-up and analyze the data in the method of statistics.Results: 1.Pathological type.From January 1989 to June 2019,257 SCST patients were treated in Tianjin medical university central hospital,including 179 cases(69.6%)of theca cell tumor,53 cases of granulosa cell tumor(20.6%),11 cases of Sertoli-Leydig cell tumor(4.3%),2 cases(0.5%)of Cellular fibroma,2 cases(0.8%)of sclerosing stromal tumor,2 cases(0.8%)of steroid cell tumor in,1 case(0.4%)of Leydig cell tumor,1 case(0.4%)of malignant steroid cell tumor and 1 case(0.4%)of fibrosarcoma.2.Clinical manifestation.Most patients with principal complaints of atypical symptoms such as pelvic mass,abdominal pain,abdominal distension and so on.Among them,106 patients(41.2%)were found pelvic mass by physical examination,81 cases(31.5%)had abdominal pain,and 33 cases(12.8%)had abdominal distension.Some patients had symptoms related to steroid secretion,including 42 patients(16.3%)had postmenopausal vaginal bleeding,16patients(6.2%)had irregular vaginal bleeding,13 patients(5.1%)had amenorrhea,3 patients(1.2%)were hairy and had alopecia,and 4patient(1.6%)of infertility.3.Supplementary Examination.Pathologic examination of endometrium was performed in 183 patients,among which 148 patients(81.0%)had no endometrial lesions,27 patients(14.8%)had simple hyperplasia,5 patients(2.7%)had complex hyperplasia,1(0.5%)had atypical hyperplasia and 2(1.0%)had endometrial cancer.According to the imaging diagnosis,the coincidence rate of b-ultrasound,MRI,CT and pelvic MRI was 88.7%,90.5% and 97.7%,respectively.Preoperative d-dimer detection was performed in 197 patients,among which 54 patients(27.4%)were abnormal,with an increased range of 43->10000ng/ml.Among the 222 patients who received serum tumor marker detection before surgery,81 patients(36.5%)had increased CEA(>5ng/ml),with an increased range of 1.3-7.5 ng/ml,68 patients(30.6%)had increased CA125(>35U/ml),with the increased range of 0.6->1000 U/ml,49 patients(22.1%)had increased AFP(>8.78ng/ml),with the increased range of 0.1->2000 ng/ml,and 12 patients(5.4%)had increased CA199(> 37U/ml),with the increased range of 4.4-505 U/ml.Only 118 patients received HE4 detection preoperatively,4 patients were higher than normal(140pmol/L)among them,with the increased range of 2.8-122.5pmol/L.Among the 187 patients who received serum sex hormone detection before the operation,6 patients(3.2%)had increased estradiol,and 47(25.1%)had increased testosterone.Those with the highest estradiol and testosterone were the same one SLCT patients,whose estradiol >1000pg/ml and testosterone>396 ng/dl.4.Operation and treatment.All the patients in this study were treated by surgery at the time of the initial diagnosis.Laparoscopic surgery was performed in 67 cases,while transabdominal surgery was performed in the other 190 patients.Among them,245 patients(95.3%)had unilateral ovarian tumors(left:right = 166:79),12 cases involved bilateral ovaries.Most of the tumors were solid or cystic solid,cystic tumors were rare.About 16.3% of the non-benign patients had tumor metastasis,most of which were abdominal metastases.The largest diameter of metastases seen during the operation was 13 cm.After the first operation,34 patients received chemotherapy,including 24 patients(70.6%)at stage Ⅰ,3 patients(8.8%)at stage Ⅱ,6 patients(17.6%)at stage Ⅲ and 1 patient(3.0%)at stage IV.The main chemotherapy regimens included TP regimen,VAC regimen,PVB regimen,BEP regimen and so on.5.Prognosis We followed 49 non-benign patients,of whom 7(14.3%)relapsed,with a PFS of 4-216 months and an average of 96 months.4 patients(8.2%)eventually died of recurrence and/or metastasis of malignant cord mesenchymal tumors,and 19 patients were lost to follow-up.The natural pregnancy rate was 57.9% in 19 patients received fertility preserving surgery.Conclusion: 1.The sex cord stroma tumors are mostly benign.Most of the malignant patients were at early stage when the time of initial diagnosis and had a good prognosis.2.The clinical manifestations of most SCST patients were abdominal pain,abdominal distension or pelvic masses found on physical examination;a few patients showed symptoms related to steroid hormone secretion,mainly irregular vaginal bleeding and amenorrhea,and a few showed masculinity and infertility,patients with endometrial malignancy usually present with vaginal discharge.3.B-ultrasound combined with color doppler is the preferred imaging examination in clinic.The application of MRI,CT and PET-CT is helpful to improve the diagnostic coincidence rate.Hemorrhage,necrosis,ulceration of tumors and high abnormal values of sex hormones may indicate malignancy.4.Comprehensive stage surgery is the preferred method of treatment,and fertility preserving surgery is feasible for women of childbearing age who have fertility requirements and whose tumors are confined in the ovary.5.Patients with malignancy tend to have long-term recurrence,and the prognosis of patients with recurrence is poor.FIGO stage and tumors’ appearance(metastasis,hemorrhage,necrosis,and ulceration)may affect recurrence.Increased innhibin or testosterone after surgery may indicate tumors’ progression or recurrence. |
PDF Full Text Request