外阴转移为首发表现的广泛复发型高级别浆液性卵巢癌一例

doi:10.12280/gjfckx.20251489

摘要/Abstract

摘要：

高级别浆液性卵巢癌（high-grade serous ovarian carcinoma，HGSOC）复发多局限于腹膜腔，外阴转移极为罕见。报告1例HGSOCⅠC期患者初治缓解逾5年后，先出现孤立性腹股沟淋巴结转移，继而以多发性外阴结节作为广泛系统性复发的首要表现。活检病理符合转移性HGSOC，PET/CT提示全身多部位转移，糖类抗原125（carbohydrate antigen 125，CA125）显著升高。经白蛋白结合型紫杉醇+卡铂+贝伐珠单抗方案治疗后，患者实现临床与生化缓解，但反复出现重度骨髓抑制，影响治疗可持续性。本病例提示罕见外阴转移可作为HGSOC全身播散的“哨兵”，强调随访中全面体格检查的重要性；对于多线治疗后复发患者，需在有效治疗与耐受性之间寻求平衡，并依据分子特征探索个体化维持与后续治疗策略。

关键词: 卵巢肿瘤, 癌, 肿瘤复发，局部, 肿瘤转移, 病例报告, 高级别浆液性卵巢癌

Abstract:

Recurrence of high-grade serous ovarian carcinoma (HGSOC) is usually confined to the peritoneal cavity, with vulvar metastasis being extremely rare. We report a case of HGSOCⅠC who achieved initial remission for over 5 years, and subsequently presented with isolated inguinal lymph node metastasis, followed by multiple vulvar nodules as the primary manifestation of extensive systemic recurrence. Biopsy pathology was consistent with metastatic HGSOC. PET/CT revealed metastases in multiple sites throughout the body, and carbohydrate antigen 125 (CA125) was significantly elevated. Following treatment with a regimen of albumin-bound paclitaxel+carboplatin+bevacizumab, the patient achieved biochemical and clinical remission. However, severe hematological toxicity occurred repeatedly, impacting treatment sustainability. This case suggests that rare vulvar metastasis may serve as a "sentinel" for systemic dissemination of HGSOC, highlighting the importance of comprehensive physical examination during follow-up. For patients experiencing recurrence after multiple lines of therapy, a balance must be sought between efficacy and tolerability, with individualized maintenance and subsequent treatment strategies explored based on molecular characteristics.

Key words: Ovarian neoplasms, Carcinoma, Neoplasm recurrence, local, Neoplasm metastasis, Case reports, High-grade serous ovarian carcinoma

陈思琦, 陈友国, 周金华, 丁红梅, 施秀, 马晶晶, 王嘉雪, 倪笑妍, 李思宇. 外阴转移为首发表现的广泛复发型高级别浆液性卵巢癌一例[J]. 国际妇产科学杂志, 2026, 53(4): 402-405.

CHEN Si-qi, CHEN You-guo, ZHOU Jin-hua, DING Hong-mei, SHI Xiu, MA Jing-jing, WANG Jia-xue, NI Xiao-yan, LI Si-yu. Vulvar Metastasis as the Initial Presentation of Widespread Recurrent High-Grade Serous Ovarian Carcinoma: A Case Report[J]. Journal of International Obstetrics and Gynecology, 2026, 53(4): 402-405.

图/表 3

图1 外阴肿物活检病理图注：肿瘤细胞呈巢团状浸润性生长，细胞异型性明显，核浆比例增高，核深染、染色质粗糙，可见明显核仁及核分裂象，部分区域可见坏死及淋巴细胞浸润；HE染色×200，标尺=100 μm。

图2 PET/CT图注：A 全身冠状面，全身多部位（外阴、腹膜）及多发淋巴结异常FDG增高；B 盆腔水平面，盆腔及双侧腹股沟区FDG增高；C 腹部水平面，肝周包膜、腹膜的弥漫性增厚及FDG增高。

图3 HGSOC外阴转移病灶治疗期间图像注：A 2025年7月16日阴阜广泛肿瘤样改变，大阴唇红肿；B 2025年8月12日阴阜暗红色斑块状，溃疡面愈合，上覆鳞屑； C 2025年9月2日鳞屑消退，可见少许暗红色斑疹；D 2025年10月23日斑疹持续消退。

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