复旦大学上海医学院妇产科学系2009级六年制妇产科学课件 Ovarian tumor.pptVIP

Ovarian tumor Wei Jiang, M.D., Ph.D. Attending of Ob Gyn Ob Gyn Hospital, Fudan University 419 Fangxie Road, Shanghai jw52317@ Overview Key points Case discussion What is the difference between cancer and tumor? What do you think? Primary ovarian tumors Epithelial: serous; mucinous; endometroid Benign Borderline Malignant ? Germ cell tumors ? Sex cord (gonadal stromal) tumors Epithelial Germ cell tumors Sex cord tumors Complications Torsion 10% Rupture 1% Infection Malignancy Case discussion Case 1 A 23-year-old female presented to our hospital in April 2013 with months history of increasing facial and truncal hair, acne. The patient had been amenorrheic for 2 years prior to the onset of her virilizing symptoms. In the recent one year, she was treated as Polycystic Ovary Syndrome (PCOS) in the local hospital, but the signs and symptoms were deteriorated Physical examination revealed a 56kg, normotensive female with obvious facial hair and atrophy of the breasts. Excessive hair was present on her lower abdomen and thighs. Pelvic examination was notable for an enlarged clitoris and a 5cm right adnexal mass. Abdominal ultrasound identified a 64×52×51mm, solid, left ovarian tumor. Doppler evaluation of intratumoral blood vessels confirmed a low resistance to flow. No ascites or other abnormalities were present. A CT scan of the pelvis confirmed the ultrasound findings and detected no adrenal gland enlargement or tumor. Laboratory analysis revealed normal values of folicle stimulating hormone (FSH), luteinising hormone (LH), serum prolactin (PRL) and cortisol. Total serum testosterone was 3.68ng/ml (normal 0.15-0.51ng/ml), Clinical thinking What is the most likely diagnosis? What should be your next steps? How would you confirm the diagnosis? Laparoscopic examination Identified a 6×5×5cm, enlarged right ovary. Oophorocystectomy After operation……… Pathological diagnosis: ovarian steroid cell tumor T: 1.02 Case 2 A 39-year-old, fema