卵巣成熟嚢胞性奇形腫からの悪性変化

Malignant transformation from mature cystic teratoma of the ovary.

抄録

卵巣成熟嚢胞性奇形腫が悪性化した症例を紹介する。患者は48歳の女性で、腹痛を訴えてプライマリケア医を受診した。初診時、骨盤内腫瘍は超音波検査で70×50mmであった。成熟嚢胞性奇形腫に続発した悪性腫瘍の破裂と診断され、手術（腹式子宮全摘術、両側卵巣摘出術、卵膜部分切除術）を受けた。病理診断は、成熟嚢胞性奇形腫に続発した扁平上皮癌（SCC）であった。術後パクリタキセル/カルボプラチン（TC化学療法）、塩酸ゲムシタビン/カルボプラチン（GC化学療法）による治療は無効であり、急速な病勢進行による難治性イレウスが続いた。卵巣癌の診断から7ヶ月後に病勢進行により死亡した。成熟嚢胞奇形腫の悪性化の臨床的特徴と卵巣SCCの治療について考察した。

We present a case of malignant change of an ovarian mature cystic teratoma. Our patient was a 48-year-old woman and she visited a primary care doctor presenting with abdominal pain. At her first visit, her pelvic tumor measured 70 × 50 mm by ultrasonography. She was diagnosed as rupture of the malignant tumor occurred secondary to mature cystic teratoma and she took the surgery (abdominal total hysterectomy, bilateral oophorectomy and partial omentectomy). Pathologic diagnosis was squamous cell carcinoma (SCC) occurred secondary to mature cystic teratoma. Treatment with paclitaxel/carboplatin (TC chemotherapy) and gemcitabine hydrochloride/carboplatin (GC chemotherapy) after operation was not effective, and the refractory ileus resulting from rapid progression of the disease continued. She was died of disease progression 7 months after the diagnosis of ovarian cancer. We discuss about the clinical characteristics of malignant transformation of mature cystic teratoma and considered about the treatment of the ovarian SCC.