| Objective:To analyze and summarize pathogenesis,clinical and pathological features,diagnosis and treatment process,prognosis and other related issues of ovarian diffuse large B cell lymphoma and to review domestic and foreign relevant literature with the purpose of mastering characteristics of ovarian diffuse large B cell lymphoma and its diagnosis and treatment procedures.It aims to standardize diagnosis and treatment process of clinical physician,lower the rate of of misdiagnosis and mistreatment,achieve timely referral,avoid delayed treatment and improve prognosis.Methods:A total of 4 cases definitely diagnosed with ovarian diffuse large B cell lymphoma via histopathology in the obstetrics and gynecology department of Qilu Hospital of Shandong University from thelst January 2000 to the 1st December 2018 were included in this study.Retrospective analysis was performed on collected clinical data and relevant domestic and foreign literature was retrieve and reviewed.Results:1.These four patients aged 45-74 years old,averagely 55 years old.The disease courses were from a dozen days to over 11 months.2.Clinical manifestations:these four patients came to the hospital mostly due to abdominal distention,anorexia and pelvic mass.Among them,two cases were complicated with fever,weakness and hidrosis.3.Auxiliary examinations:Serum CA125 of 3 patients increased,with the range of 625.1-1455 U/mL,averagely 823 U/mL(normal value 0-35U/ml),Serum CA125 was normal in one patient,low-echo adnexal masses were found in 4 cases during gynecological ultrasound examination and the bood flow signals were rich.Among them,3 cases were found with a small amount of effusion in abdominopelvic cavity.The lesions of 2 cases were in bilateral and those of another 2 cases were on the right side.4.Treatment:All four patients underwent total abdominal hysterectomy+bilateral salping-oophenrectomy+omentectomy+lesionectomy.After operation,all patients received chemotherapy using R-CHOP shceme for 4-6 cycles.The median follow-up visit time in this paper was 20 months(4-98 months)and one case fell out.Till the day of follow-up visit,the rest three cases survived.Conclusion:1.Ovarian diffuse large B cell lymphoma was very rare and its clinical manifestations lack of specificity,so it is easily confused with epithelial ovarian cancer,with a higher misdiagnosis rate.The diagnosis must be confirmed by histopathology(Some patients need immunohistochemistry);2.Due to low occurrence rate and shortage of prospective clinical research,there is no unified diagnosis and treatment specification.In the early stage,total abdominal hysterectomy+bilateral salping-oophenrectomy+omentectomy+lesionectomy was the primary treatment and in the advanced stage,primary cytoreductive surgery+pelvic lymphadencetomy can be peformed;3.The standard postoperative chemotherapy plan was CHOP scheme based on antharcycline(cyclophosphamide+Doxorubicin+vincristine+prednison).For immunohistochemical CD20(+)lymphoma,CHOP plus merlova chemotherapy is the first choice.Chemotheray can be used for those with postoperative lesion residual and those who are intolerant to chemotherapy.For young women with tumors confined to one side of the ovary,fertility preservation surgery is feasible,but a biopsy of the opposite side of the ovary is required;4.For patients with failed treatment or repeated recurrence,most treatment centers adopted intensive treatment plus bone marrow or hematopoietic stem cell transplantation and som,which are mainly related to the number of extranodal lesions,international prognosis index(IPI),pathological to patients can use biological regulators,But there is no uniform probability for its effectiveness;5.The prognosis of diffuse large B cell lymphoma of the ovary can involve many aspectsypes,whether primary or secondary,treatment schemes,number of extranodal lesions,etc. |
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