幼女原发性阴道内胚窦瘤21例临床分析

doi:10.6040/j.issn.1671-7554.0.2018.224

山东大学学报 (医学版) ›› 2018, Vol. 56 ›› Issue (5): 41-45.doi: 10.6040/j.issn.1671-7554.0.2018.224

• • 上一篇

幼女原发性阴道内胚窦瘤21例临床分析

王涛¹,曹冬焱¹,俞梅¹,张颖¹,刘巍²,宋红梅³,沈铿¹,郭丽娜⁴,杨佳欣¹

中国医学科学院北京协和医学院北京协和医院 1.妇产科;2.放射介入科;3.儿科;4.病理科, 北京 100730

收稿日期:2018-02-14 发布日期:2022-09-27
通讯作者: 杨佳欣. E-mail:YangJiaXin@pumch.cn
基金资助:
国家科技部十一五国家科技支撑计划(2008BAI57B02)

Clinical characteristics of 21 cases with primary vaginal endodermal sinus tumor in children

WANG Tao¹, CAO Dongyan¹, YU Mei¹, ZHANG Ying¹, LIU Wei², SONG Hongmei³, SHEN Keng¹, GUO Lina⁴, YANG Jiaxin¹

1. Department of Obstetrics and Gynecology;
2. Department of Interventional Radiology;
3. Department of Pediatrics;
4. Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Science &
Peking Union Medical College, Beijing 100730, China

Received:2018-02-14 Published:2022-09-27

摘要/Abstract

摘要： 目的探讨幼女原发性阴道内胚窦瘤的临床特点、治疗与结局。方法回顾性分析1997年1月至2017年12月间21例经病理证实的原发性阴道内胚窦瘤, 患儿4个月~4岁,中位年龄11个月,<1岁者14例,所有患儿借助宫腔镜下阴道手术,明确病理诊断。给予PEB(顺铂、依托泊苷、博莱霉素)方案为主的化疗,监测患儿血清甲胎蛋白(AFP)水平。结果 21例患儿均表现为阴道出血或血性分泌物,部分出现阴道脱落肿物。接受化疗3~13个疗程,中位5个疗程,20例患儿达到完全缓解(95.2%)。中位随访时间44个月(4个月~20年),19例存活,生存率90.5%;1例肿瘤进展死亡,2例复发,但再次化疗后达到完全缓解。1例患儿在初始治疗期间死于感染和心脏衰竭。结论幼女阴道内胚窦瘤非常罕见,对化疗十分敏感,治疗以保守手术和经典的PEB方案化疗为主,联合血清标志物AFP和阴道检查,评估疗效。

关键词: 阴道内胚窦瘤, 幼女, 化疗

Abstract: Objective To analyze the clinical characteristics,treatment,and outcomes of children with primary vaginal endodermal sinus tumor. Methods A retrospective analysis was performed on clinical and pathological data of 21 children with pathologically confirmed primary vaginal endodermal sinus tumor between January 1997 and December 2017.The patients ranged from 4 months to 4 years old, with median age being 11 months old. There were 14 cases younger than one year old. All patients were treated with chemotherapy, mainly PEB(cisplatin, etoposide, bleomycin)after an IV port implanted into subclavian vein. Detection of serum α-fetoprotein(AFP)level, examination under anesthesia and biopsy by hysteroscope were performed before and after treatment to evaluate the tumor status. Results Bleeding or blood-tinged discharge was the most common clinical presentation. The patients received chemotherapy for a median of 5 courses(ranged from 3 to 13 courses). Twenty patients obtained complete remission(95.2%). The patients were followed up for a median of 44 months(ranged from 4 months to 20 years). Nineteen patients(90.5%)remained alive. 山东大学学报 (医学版)56卷5期 -王涛,等.幼女原发性阴道内胚窦瘤21例临床分析 \=-One child died of disease progression. One child received 4 courses of PEB chemotherapy and died of infection and heart failure. Two patients were recurrent but obtained complete remission after chemotherapy again. Conclusion Vaginal endodermal sinus tumors are rare in children and extremely sensitive to chemotherapy. To allow preservation of sexual and reproductive function, PEB chemotherapy with conservative surgery should be considered for children with vaginal endodermal sinus tumor. Combination of serum AFP with vaginal examination are reliable evaluating methods.

Key words: Vaginal endodermal sinus tumor, Children, Chemotherapy

中图分类号:

R574

王涛,曹冬焱,俞梅,张颖,刘巍,宋红梅,沈铿,郭丽娜,杨佳欣. 幼女原发性阴道内胚窦瘤21例临床分析[J]. 山东大学学报 (医学版), 2018, 56(5): 41-45.

WANG Tao, CAO Dongyan, YU Mei, ZHANG Ying, LIU Wei, SONG Hongmei, SHEN Keng, GUO Lina, YANG Jiaxin. Clinical characteristics of 21 cases with primary vaginal endodermal sinus tumor in children[J]. Journal of Shandong University (Health Sciences), 2018, 56(5): 41-45.

参考文献

[1] Davidoff AM, Hebra A, Bunin N, et al. Endodermal sinus tumor in children[J]. J Pediatr Surg, 1996, 31(8): 1075-1079.
[2] Goyal S, Puri A, Mishra K, et al. Endodermal sinus tumor of vagina posing a diagnostic challenge and managed by chemotherapy and novel posterior sagittal surgical approach: lessons learned[J]. J Obstet Gynaecol Res, 2014, 40(2): 632-636.
[3] Trotti A, Colevas AD, Setser A, et al. CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment[J]. Semin Radiat Oncol, 2003, 13(3): 176-181.
[4] Tao T, Yang J, Cao D, et al. Conservative treatment and long-term follow up of endodermal sinus tumor of the vagina[J]. Gynecol Oncol, 2012, 125(2): 358-361.
[5] 刘文旭,刘唐彬,谢家伦,等.婴幼儿阴道内胚窦瘤五例[J]. 中华小儿外科杂志, 2001, 22(1): 39.
[6] Handel LN, Scott SM, GillerRH, et al. New perspectives ontherapy for vaginal endodermal sinus tumors[J]. J Urology, 2002, 168: 687-690.
[7] 杨军英,靳琳.新生儿阴道内胚窦瘤一例[J].中华妇产科杂志, 1999, 34(7): 427.
[8] Watanabe N, Okita H, Matsuoka K, et al. Vaginal yolk sac(endodermal sinus)tumors in infancy presenting persistent vaginal bleeding[J]. J Obstet Gynaecol Res, 2010, 36(1): 213-216.
[9] Arora M, Shrivastav RK, Jaiprakash MP. A rare germ-cell tumor site: vaginal endodermal sinus tumor[J]. Pediatr Surg Int, 2002, 18(5-6): 521-523.
[10] 李卫华,曹冬焱,杨佳欣,等.幼少女原发性阴道恶性肿瘤25 例临床特点[J].协和医学杂志, 2016, 7(4): 269-274. LI Weihua, CAO Dongyan, YANG Jiaxin, et al. Clinical characteristics of 25 cases with primary vaginal malignancies in young girls[J]. Med J PUMCH, 2016, 7(4): 269-274.
[11] Fang X, Du W, Wang Q, et al. Endoscopic surgery combining chemotherapy for vaginal yolk-sac tumor: a case report[J]. Eur J Gynaecol Oncol, 2015, 36(3): 335-338.
[12] Lacy J, Capra M, Allen L. Endodermal sinus tumor of the infant vagina treated exclusively with chemotherapy[J]. J Pediatr Hematol Oncol, 2006, 28(11): 768-771.
[13] Xie W, Shen K, Yang J, et al. Conservative management of primary vaginal endodermal sinus tumor and rhabdomyosarcoma[J]. Oncotarget, 2017, 8(38): 63453-63460.
[14] O'Sullivan JM, Huddart RA, Norman AR, et al. Predicting the risk of bleomycin lung toxicity in patients with germ-cell tumors[J]. Ann Oncol, 2003, 14(1): 91-96.

相关文章 15

[1]	阮祥燕,程姣姣,杜娟,谷牧青. 卵巢组织冷冻保存[J]. 山东大学学报 (医学版), 2022, 60(9): 24-30.
[2]	秦静,杨飞,陈谦,夏涵岱,刘延国,王秀问. 晚期驱动基因阴性、PD-L1表达阴性非鳞非小细胞肺癌一线治疗方案的网状Meta分析[J]. 山东大学学报 (医学版), 2022, 60(7): 74-82.
[3]	初竹秀,赵文静,李小燕,孔晓丽,马婷婷,江立玉,杨其峰. 218例女性乳腺癌患者行新辅助化疗及伴随分子标志物改变的临床价值[J]. 山东大学学报 (医学版), 2021, 59(9): 130-139.
[4]	张喜琴,祝守慧,刘宁,王玉,陈家帧,胡旭东. PEG-rhG-CSF对80例小细胞肺癌同步放化疗预防中性粒细胞减少的临床观察[J]. 山东大学学报 (医学版), 2020, 58(12): 43-46.
[5]	王瑾晖,杨佳欣,袁振,曹冬焱,沈铿,黄惠芳,吴鸣,潘凌亚,郭丽娜. 复发和未控卵巢恶性生殖细胞肿瘤保留生育功能的治疗[J]. 山东大学学报 (医学版), 2018, 56(5): 35-40.
[6]	陈波,张磊. 2017年乳腺癌新辅助治疗进展[J]. 山东大学学报 (医学版), 2018, 56(1): 12-16.
[7]	石爱平,徐格格,解新鹏. St.Gallen会议乳腺癌新辅助治疗回顾[J]. 山东大学学报 (医学版), 2018, 56(1): 6-11.
[8]	王殊,彭媛. 从2017年美国临床肿瘤学会大会报告看早期乳腺癌治疗加减法[J]. 山东大学学报 (医学版), 2018, 56(1): 17-21.
[9]	朱久俊,焦得闯,乔江华,王丽娜,马有钊,阳跃,卢振铎,刘真真. 新辅助化疗后乳腺病理完全缓解与腋窝病理完全缓解的关联性[J]. 山东大学学报 (医学版), 2018, 56(1): 32-37.
[10]	律慧敏,张梦玮,牛李敏,曾惠爱,闫敏. 国产多西他赛单药治疗晚期乳腺癌的疗效及安全性[J]. 山东大学学报 (医学版), 2018, 56(1): 45-49.
[11]	殷雷,殷睿,李文佳,刘帅,吕家驹. CYLD抑制自噬提高膀胱癌细胞吉西他滨化疗敏感性[J]. 山东大学学报（医学版）, 2017, 55(8): 1-6.
[12]	董秀红. 认知催眠疗法减轻胃癌化疗患者癌因性疲乏的疗效观察[J]. 山东大学学报（医学版）, 2016, 54(7): 56-59.
[13]	徐志宏,刘荣凤,王晓翔,冯莉,姚铁柱,刘红. 养正消积胶囊联合化疗治疗转移性乳腺癌的临床疗效及安全性[J]. 山东大学学报（医学版）, 2016, 54(5): 79-83.
[14]	刘永亮,王秀问. 老年直肠癌术后辅助化疗相关病理特征及预后多因素分析[J]. 山东大学学报（医学版）, 2016, 54(1): 48-51.
[15]	唐萍, 彭丽婧, 王林娟. 化疗药物外渗1例护理报告[J]. 山东大学学报（医学版）, 2014, 52(Z2): 160-160.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed

幼女原发性阴道内胚窦瘤21例临床分析

Clinical characteristics of 21 cases with primary vaginal endodermal sinus tumor in children

PDF (PC)

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

多维度评价

本文评价

推荐阅读 0