后腹膜卵黃囊瘤一例

熊茜?古健

【摘要】后腹膜卵黃囊瘤臨床罕見，容易漏診或誤診。該文報(bào)道了一例經(jīng)術(shù)后病理檢查確診為后腹膜卵黃囊瘤的年輕女性患者，患者因腹脹1周入院，術(shù)前影像學(xué)檢查提示卵巢來(lái)源惡性腫瘤可能，行剖腹探查術(shù)中發(fā)現(xiàn)腫瘤來(lái)源于后腹膜，雙側(cè)卵巢未見腫物，予后腹膜腫物切除術(shù)，并按卵黃囊瘤的治療予依托泊苷150 mg、順鉑900 mg、博來(lái)霉素15 mg（BEP方案）靜脈化學(xué)治療，共化學(xué)治療6次，第3次化學(xué)治療后復(fù)查甲胎蛋白降至正常，彩色多普勒超聲檢查未見明顯異常腫物，隨訪1年未見腫瘤復(fù)發(fā)。該例診治過(guò)程提示，影像學(xué)檢查結(jié)合甲胎蛋白檢測(cè)有助于卵黃囊瘤的診斷及預(yù)后評(píng)估，手術(shù)加輔助化學(xué)治療對(duì)卵黃素瘤有良好的療效。

【關(guān)鍵詞】后腹膜;卵黃囊瘤;甲胎蛋白;治療

Primary retroperitoneal yolk sac tumor： a case report Xiong Qian， Gu Jian. Department of Gynecology， the Third Affiliated Hospital of Sun Yat-sen University， Guangzhou 510630， China

【Abstract】Primary retroperitoneal yolk sac tumor is a rare disease in clinical setting， which is likely to be misdiagnosed or miss the diagnosis. In this article， a 25-year-old woman who was pathologically diagnosed with primary retroperitoneal yolk sac tumor was reported. She was admitted to our hospital due to abdominal distention for one week. Preoperative imaging examination suggested the possibility of malignant ovarian tumor. During the exploratory open surgery， it was found that the tumor was derived from the retroperitoneum， and no tumor was found in both ovaries. The tumor was surgically removed. According to the treatment of yolk sac tumor， chemotherapy consisting of etoposide 150 mg + carboplatin 900 mg + bleomycin 15 mg （BEP） was delivered for 6 cycles. After the third cycle of chemotherapy， the alpha-fetoprotein （AFP） level was decreased to normal range. No abnormal tumor was found by color Doppler ultrasound. No tumor recurrence was observed during 1-year follow-up. This case prompts that imaging examination combined with AFP detection contribute to clinical diagnosis and prognosis evaluation of primary retroperitoneal yolk sac tumor. Surgery in combination with chemotherapy yields high clinical efficacy.

【Key words】Retroperitoneum;Yolk sac tumor;Alpha-fetoprotein;Treatment

卵黃囊瘤又稱內(nèi)胚竇瘤，是一種由胚外結(jié)構(gòu)卵黃囊發(fā)生惡變的原發(fā)性生殖細(xì)胞腫瘤[1]。腹膜外生殖細(xì)胞腫瘤常見于縱隔、后腹膜及骶尾部等部位[2]。生殖腺以外的卵黃囊瘤考慮是胚胎發(fā)生過(guò)程中生殖細(xì)胞沿泌尿生殖脊錯(cuò)誤遷移的結(jié)果，占所有成人生殖細(xì)胞惡性腫瘤的2% ～ 5%[3]。性腺以外的卵黃囊瘤少見，原發(fā)于后腹膜的卵黃囊瘤更為罕見?，F(xiàn)將近年我科收治的1例后腹膜卵黃囊瘤診治過(guò)程報(bào)道如下，以提高臨床醫(yī)師對(duì)該病的診療水平。

病例資料

一、病史及體格檢查

患者女，25歲。因腹脹1周于2018年6月2日收入院?；颊呒韧w健，1周前無(wú)明顯誘因出現(xiàn)腹脹，為持續(xù)性脹痛，休息后明顯緩解，曾于當(dāng)?shù)蒯t(yī)院就診，行盆腔MRI檢查提示下腹部巨大占位性病變，為進(jìn)一步診治來(lái)我院就診。起病以來(lái)患者大小便正常，已婚未育，G0P0，月經(jīng)規(guī)律。

入院體格檢查：體溫36.8?C，脈搏86次/分，

呼吸16次/分，血壓105/68 mm Hg（1 mm Hg = 0.133 kPa）。發(fā)育正常，姿勢(shì)步態(tài)正常。婦科檢查提示外陰呈已婚未產(chǎn)型，陰道后穹隆膨隆，子宮頸無(wú)舉痛，子宮左上方可觸及一大小約17 cm×15 cm×13 cm實(shí)性包塊，邊界清楚，活動(dòng)度差，無(wú)壓痛。

二、實(shí)驗(yàn)室及輔助檢查

血常規(guī)示血紅蛋白74 g/L，紅細(xì)胞2.97×1012/L，

白細(xì)胞7.82×109/L，中性粒細(xì)胞0.722，淋巴細(xì)胞0.202，血小板計(jì)數(shù)306×109/L。血清癌抗原125（CA125）74.1 kU/L，人附睪蛋白4 30.1 pmol/L，血清甲胎蛋白10 341.2 μg/L，癌胚抗原（CEA）0.3 μg/L，血清人絨毛膜促性腺激素（HCG）5 U/L。