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1 临床资料1.1 一般资料 患者女性,17岁,未婚,学生。腹部包块1年余入院,伴恶心,腰痛,月经正常。查体腹部可触及一巨大包块,质硬。CT示下腹部巨大实性占位性病变。术中见包块蒂部起源于右侧卵巢,右侧输卵管变粗变硬,与包块粘连密切,右侧卵巢有一绿豆大囊性包块。合并淡黄色腹水2000mL,行单侧附件切除术。临床诊断;右卵巢恶性肿瘤。1.2 病理检查 巨检:肿物灰褐色,椭圆形,大小约20cm×20cm×15cm。实性,表面光滑,包膜完整。切开肿块为灰黄色,油腻状,质坚硬,可见大小不等的小囊腔,最大约3cm×2cm×1cm,最小约1cm ×0.5cm ×0.5cm内为灰黄色液体。表面可见蚕豆大菜花样结节。镜检:瘤细胞为肥胖短梭形,细胞核圆形,卵圆形,细胞排列成交错束状,瘤细胞被纤维结缔组织分隔。病理诊断:①右卵巢卵泡膜细胞瘤;②浆液性表面乳头状瘤;③卵巢滤泡囊肿及黄体囊肿。随访:术后至今1年未发现阳性体征。2 讨论
1 Clinical data 1.1 General information Patient Female, 17 years old, single, student. Abdominal mass more than 1 year hospitalization, with nausea, back pain, normal menstruation. Physical examination of the abdomen can reach a huge mass, hard. CT showed a large solid abdominal mass lesions. Intraoperative see package mass pedicle originated in the right ovary, the right tubal become thicker and harder, and adhesions close mass, the right ovary has a mung bean cystic mass. Combined yellowish ascites 2000mL, line unilateral excision. Clinical diagnosis; right ovarian cancer. 1.2 pathological examination gigantic: mass taupe, oval, size of about 20cm × 20cm × 15cm. Solid, smooth surface, complete capsule. Cut the tumor is greyish yellow, oily, hard, visible small cysts of varying sizes, the maximum about 3cm × 2cm × 1cm, the smallest about 1cm × 0.5cm × 0.5cm within the gray-yellow liquid. Visible broad bean dish surface nodules. Microscopic examination: tumor cells are short, fusiform, nucleus round, oval, cells arranged in staggered beam, the tumor cells are separated by fibrous connective tissue. Pathological diagnosis: ① right ovarian follicular cell tumor; ② serous papillomatosis; ③ ovarian follicular cyst and luteal cyst. Follow-up: One year after operation, no positive signs were found. 2 discussions