| Objective: Primary squamous cell carcinoma of the ovary is a squamous cell carcinoma that occurs in the ovary,It is a rare malignancy and its prognosis is worse than other epithelial ovarian cancer.The pathogenesis and the cause of this tumor is still not clear.Its clinical symptoms is Similar to other ovarian cancer,It is difficult to diagnosis this disease in the early time,also not have a effective or preoperative methods to diagnosis,It depends on the histopathological diagnosis through surgery,It is easy to be misdiagnosed that the patient would be delayed the treatment or can't be received effective surgery treatment.At present,there is still a lack of standard treatment for this disease.This article will retrospective analysis for 23 cases of PSCC's clinical data,summary the characteristics,in order to improve the understanding of such tumor,cause our attention,to help the patients that can get better treatment.Methods:To retrospectively analyze the characteristics,clinical manifestations,auxiliary examination,treatment and prognosis of PSCC for 23 cases which are collected from Affiliated Tumor Hospital of Guangxi MedicalUniversity,Yulin Tumor Hospital and The First People 's Hospital of Yulin in January 1997 to January 2017.Results:1.Tumor characteristics: the 23 patients' age are range from 35 years to82years,mainly in the 40-60 age group,the median age is 54.00 years,the mean age is 55.30 years.The ratio of no menopause'number to menopause' was 1:2.8,the average time of menopause is 10.94 years,and PSCC occurred mainly in the period of menopause.The incidence of PSCC is mainly from Squamous cell carcinoma arising from mature cystic teratoma(SCC-MCT),It is accounted for 82.61 %,mainly unilateral(86.96%),the left side more common(60.00%).The tumor diameter was 5.3-21 cm and the average diameter was 11.5 cm.The degree of tumor differentiation was G3(65.22%),G2(17.39%)and G1(17.39%).Regardless of the size of the tumor diameter,G3 is predominantly.2.Clinical symptom: the clinical stage of PSCC for 23 cases to the early(?,?)-based.Regardless of the period is early age or advanced age,the abdominal pain is the main symptom,and can be the only symptom,may be associated with antibiotic treatment is not ideal,unexplained repeated fever,and accompanied by changes in bowel movements,low back pain,dry cough.Can be combined with varying degrees of anemia and renal insufficiency.3.Auxiliary examination: The positive rate of SCC-Ag,CYFRA21-1 and CA125 was relatively high in 23 cases of PSCC,and 10 cases(43.48%)were positive for SCC-Ag,10 cases(43.48%)were positive for CYFRA21-1,12cases(52.17%)were positive for CA125,other tumor markers were varying degrees and the proportion of the increase.Bultrasound mainly for the pelvic mixed mass,CT,MR mainly for the attachment area of solid or cystic solid space,wall thickening significantly.4.treatmentThe treatment with different clinical stages.(1)?A 4 cases,4 cases were surgery + chemotherapy.(2)?C 5 cases,2 cases of were surgery,3 cases were surgery +chemotherapy.(3)?A only 1 case,was surgery + chemotherapy.(4)?B 8 patients,2 cases were surgery,5 cases were surgery +chemotherapy,1 case was chemotherapy.(5)?B 2 cases,2 cases were surgery + chemotherapy.(6)?C 3 cases,3 cases were surgery + chemotherapy.Surgical conditions and postoperative pathology with different clinical stages:For the 23 cases of PSCC,19 cases had uterine attachment + double attachment resection.It is included by 4 cases of stage ?A,4 cases of stage ?C,1 case of stage ?A,5 cases of stage ?B,2 cases of stage ?B and 3 cases of stage ?C.1 case of stage IIB did not remove the uterus and accessories.1 case of stage IC,2 cases of stage IIB only resection of the annex.There were 13 cases of retroperitoneal lymphadenectomy,including 3 cases of stage ?A,all were pelvic lymph node dissection + abdominal aortic lymph node dissection.4cases of stage IC,2 cases were pelvic lymphadenectomy,2 cases were pelvic lymphadenectomy + Abdominal aortic lymph node dissection.? A stage only 1case was pelvic lymphadenectomy.stage? B 4 cases,1 case was pelvic lymph node dissection,3 cases were pelvic lymph node dissection + abdominal aortic lymph node dissection.In addition to retroperitoneal lymph node resection,one of stage? mesenteric lymph node resection,1 case of stage? C period of intestinal lymph node and mesenteric lymph node dissection,12 cases wewpostoperative pathology did not show tumor metastasis,1 case of stage ?C abdominal aortic Lymph node metastasis.1 case of intestinal lymph node metastasis,2 cases of mesenteric lymph nodes were no metastasis.There were13 cases of omentum resection,including 2 cases of stage ?A,4 cases of stage?C,4 cases of stage ?B,2 cases of stage ?C,11 cases' postoperative pathology without tumor metastasis,2 cases had tumor invasion,both are stage?C.There were 6 cases of appendectomy,including 3 cases of stage ?C,1case of stage ?B,2 cases of stage ?C and 6 cases were postoperative pathology.Statistics of different chemotherapy regimens and chemotherapy with different stage:For the 23 cases of PSCC,18 patients had receive chemotherapy.Among them,1 case was chemotherapy with single drug and 17 cases were combined chemotherapy.Among them,13 cases were treated by ovarian epithelial cancer's chemotherapy method and 4 cases were treated by ovarian germ cell malignant tumor's chemotherapy method.(1)?A 4 cases,1 case used BEP one time befor surgery,then went on using BEP 4 Times after surgery,1 case used Cisplatin infusion into the abdominal cavity+ cyclophosphamide 1time,then used BVP for 1time,BEP 1time after surgery.1 case used paclitaxel + nedaplatin for 7 times after surgery.1case used paclitaxel + neda platinum for 6 times after surgery.(2)? C 5 cases,3 cases without chemotherapy,1 case used DC 1 time after surgery for 1 month because the tumor was progressing,after cytoreductive surgery,went on using DC for 5 times.1 case used DP 1 time,docetaxel + oxaliplatin 5 times after surgery.(3)IIA 1 case,used TP 1 time after surgery and did not continue to recivechemotherapy,after the cancer relapse,used TP 6 time.(4)IIB 8 cases,2 cases without chemotherapy,1 case used paclitaxel +lorplatin 1 time after biopsy;2 cases used DP after surgery,respectively 2 and 6times.2 cases used TP after surgery,respectively 2 and 3 times,due to the chemotherapy's side effects,changed TC to continue chemotherapy fo 2 times.1case used paclitaxel + neda platinum 2 times after surgery,without further treatment after 10 months of recurrence,used paclitaxel + neda platinum 8 times,10 months after the second recurrence,change docetaxel Game + oxaliplatin regimen 4 times.(5)IIIB 2 cases,1 case use lumbar,the specific unknown,1 case used CTX+ DDP 3 times after surgery,BEP 1 times.(6)IIIC 3 cases,1 case used DP chemotherapy 8 times after surgery,1 case used DP 3 times after re-cytoreductive surgery,because the tumor did not control changed liposomal adriamycin + Metaplasia chemotherapy 1 time.1case used TP 3 times,BEP 3 times after surgery,recurrence and after re-surgery used DC 3 times,due to the tumor progression change vinorelbine + tiggio 3times.5.Follow-up and prognosis(1)?A 4 cases,number 1-4.Case 1: the patient received surgery after found the tumor for 1 month,then received chemotherapy after surgery for 3 weeks,but not continue to treatment,the tumor was progressing after 5 months,received chemotherapy,no treatment,finally died,survival time was 13 months.Case 2: the patient received surgery after found the tumor for 1 month,added compreshensive staging laparotomy,after 1 month,but not continue to receive chemotherapy,after 12 months,tumor metastasis to vaginal stump,pelvic,retroperitoneal lymph node,bone of whole body,recieved chemotherapy after tumor recurrence,during the chemotherapy time,tumor partial remission,because the small intestine vaginal stump fistula failed to continue chemotherapy,stop chemotherapy 2 months,the tumor continues to progress,finally died,the survival time was 29 months.Case 3: patients with a disease for 1 year of surgical treatment(ipsilateral annex removal),due to postoperative pathology suggestive malignancy,after 5weeks to add staging surgery,postoperative chemotherapy 6 times,the current tumor-free survival,survival time of 43 months.Case 4: the patient received surgery after found the tumor for 2 months,after 2 weeks recieved chemotherapy,5 weeks after chemotherapy,added compreshensive staging laparotomy,continued chemotherapy after surgery,now is still alive without tumor,survival time is 57 months.(2)? C 5 cases,number 5-9.Case 5: the patient received surgery after found the tumor for 4 months,after 1 month the tumor was progressing,and she refused treatment,finally died,survival time was 10 months.Case 6: the patient received surgery after found the tumor for 4 years,required not to expansion othe surgery and refused chemotherapy,now is still alive without tumor,survival time is 74 months.Case 7: the patient received surgery after found the tumor for 3 weeks,because the lower limb thrombosis,she failed to further treatment,after 1 month of the surgery,the tumor was progressing,had sigmoid colon metastasis,pelvic metastasis,after 2 months of surgery,she started to chemotherapy,after chemotherapy for 1 months,had re-surgery and chemotherapy,but the tumor continueed to progress,finally died,the survival time was 18 months.Case 8: the patient received surgery after found the tumor for 1 month,after 8 days started to chemotherapy,now is still alive without tumor,survival time is 12 months.Case 9: the patient refused to chemotherapy after surgery,has been lost.(3)? A 1 cases,case 10: the patient received surgery after found the tumor for on time,and received chemotherapy,did not follow the treatment,after 10 months,discoveried the liver metastases,continued to chemotherapy,now is still alive,The survival time is 17 months.(4)? B 7 cases,number 11-14.Case 11: the patient received biopsy through open surgery after found the tumor for 2 months,due to the serious complications with poor physical condition,she did not continue to treat,finally died,survival time was 5 months.Case 12: the patient received surgery after found the tumor for on time,due to side effects of chemotherapy,she did not continue to chemotherapy,after2 months,the tumor was progressing,finally died,survival time was 12 months.Case 13: the patient received surgery after found the tumor for 2 months refused continue tochemotherapy,after 5 months,the tumor was progressing,finally died,survival time was 12 months.Case 14: the patient received surgery after found the tumor for 2 weeks 1month after added surgery,now is still alive,continue to treat,survival time is 4months.Case 15: the patients received intraperitoneal chemotherapy after found the tumor for 1 month,after 2 months of chemotherapy,she had surgical treatment,continued chemotherapy,but not chemotherapy on time,after 10 months of chemotherapy,tumor recurrence and received chemotherapy,the efficacy evaluation was tumor remission,after 8 months the tumor recurrence,alsocontinued chemotherapy,but the tumor continued to progress,finally died,survival time was 39 months.Case 16: the patient received surgery after found the tumor for 3weeks,received chemotherapy after surgery,due to poor physical fitness did not continue to chemotherapy,now is still alive without tumor,survival time was 8months.Case 17: the patient received surgery after found the tumor for 2 months,after 1 month,added surgery and chemotherapy after the surgery,now is still alive without tumor,survival time was 22 months.Case 18: the patient received surgery after found the tumor on time,,after 1month,metastasis to intestinal and recieved surgery,continued to chemotherapy,finally died,survival time was8 months.(5)? B 2 cases,number 19-20.Case 19: the patient received surgery after found the tumor on time,started chemotherapy after surgery for 5 weeks,after chemotherapy for 1 month,tumor metastasis to vaginal stump,pelvic multiple,continued to chemotherapy,because the poor physical fitness of the patient,could not tolerate chemotherapy,the tumor continued to progress,finally died,survival time was11 months.Case 20: the patient received surgery after found the tumor for 2 weeks,recieved chemotherapy after surgery,because the serious of complications and side effects from chemotherapy,no further treatment,after 11 months of follow-up,the tumor recurrence,finally died,survival time was 13 months.(6)? C 3 cases,number 21-23.Case 21: the patient received surgery after found the tumor for 1 month,started chemotherapy after the surgery for 1 month,now is still alive,continues to chemotherapy,efficacy evaluation of the most that the tumor remission,survival time is 12 months.Case 22: after surgery for 1 month,the tumor was progressing quickly,then received re-surgery and chemotherapy,the tumor continued to progress during the chemotherapy time,survival time was 10 months.Case 23: patient had surgery,and received chemotherapy after surgery,considered pelvic metastasis after chemotherapy for 1 month,re-surgery and chemotherapy.the tumor continued to progress during the chemotherapy time,finally died,the survival time was 22 months.Survival analysis of the patients showed that patients with SCC-Ag positive had a worse prognosis than the patients with SCC-Ag negative.Conclusion: PSCC is a rare type cancer of ovarian,its organization origin is more common from SCC-MCT.It is still a big challenging to diagnose PSCC before surgery,It is easy to misdiagnosis and miss diagnosis,It needs our attention that if the patient is a menopausal women,her tumor markers: SCC-Ag is positive,tumor diameter ? 10 cm,imaging examination shows the wall of the tumor is obviously thick and the enhanced scan of the tumor is obvious.For the patients who with pelvic mass,SCC examination is necessary,if the patients pelvic mass considered is mature teratoma,in order to avoid malignant transformation,it should be treated in time.PSCC intraoperative frozen biopsy requires pathologists in addition to carefully check the real part,should also be concerned about the wall thickness and nodule parts,multi-point material,and communicate fully with the surgeon to reduce missed diagnosis.The treatment of PSCC with surgery combined with adjuvant chemotherapy,the implementation of the principle of surgery and ovarian epithelial cancer is similar to the early(I),if the tumor rupture,to maintain fertility surgery shouldbe careful,whether the need for adjuvant chemotherapy is still in doubt Patients with advanced surgery if bowel resection,abdominal aortic lymph node resection may be necessary.Chemotherapy programs are diverse,there is no best chemotherapy,but are paclitaxel + platinum-based chemotherapy regimen,chemotherapy patients can delay the recurrence and progress of time,chemotherapy patients with better prognosis,radiotherapy is conducive to the treatment of PSCC Need to be further explored.PSCC is easy to progress,recurrence,progress,recurrence and late patients with poor prognosis,the clinical recurrence rate is high,SCC-Ag positive patients with worse prognosis. |
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