卵巢癌患者临床误诊分析OA

Objective To analyze the causes of clinical misdiagnosis of ovarian cancer and its preventive measures,so as to improve the diagnostic and therapeutic level of clinicians.Methods The clinical data of three patients with misdiagnosed ovarian cancer that were treated at Cangzhou People's Hospital from June 2020 to June 2023 were retrospectively analyzed.Results A postmenopausal women presented with persistent abdominal distension for 38 d.The initial CT scan showed cystic and solid masses of adnexa,massive ascites and peritoneal thickening,while the puncture pathology was negative.Combined with elevated levels of carbohydrate antigen 125(CA125)and human epididymis protein 4(HE4),ovarian cancer was suspected but could not be definitively diagnosed.The subsequent ascites exfoliative cytology was negative,and the tuberculosis-related examinations were positive,leading to a referral for suspected pelvic tuberculosis.In order to determine the etiology,laparoscopic peritoneal biopsy was performed.Pathological and immunohistochemical findings(PAX8,WT1,P53,and P16 were diffusely positive)confirmed the diagnosis of ovarian serous carcinoma stage Ⅲ C.The misdiagnosis lasted 5 d.After 4 cycles of neoadjuvant chemotherapy with Paclitaxel and Carboplatin following the definitive diagnosis,the patient underwent interval cytoreductive surgery to resect the bilateral adnexa and omental metastases.After operation,the patient received 2 cycles of chemotherapy and maintained with Nilapamide.At 6 months after operation,CA125 and HE4 returned to normal,without recurrence,and the prognosis was good.One patient was admitted due to lower abdominal pain for more than 6 h.According to the clinical symptoms and relevant examination findings,the patient was diagnosed with corpus luteum rupture and received conservative treatment with anti-inflammatory and hemostatic agents,which did not result in symptomatic relief.Laparoscopic exploration was performed under general anesthesia.Intraoperative frozen section was suggestive of ovarian cancer,and comprehensive staging surgery for ovarian cancer was subsequently carried out.Postoperative pathological examination revealed endometrioid carcinoma(moderately to well differentiated)of the right ovary.The duration of misdiagnosis was 4 d.Paclitaxel combined with Cisplatin was used for chemotherapy after operation,and after 2 cycles,the serum CA125 level decreased.The patients were followed up for 6 months,and no new lesions were identified,and the patient continues to be followed up regularly.Conclusion Ovarian cancer has similar clinical manifestations with pelvic tuberculosis and corpus luteum rupture,which should be confirmed by postoperative pathological examination and immunohistochemical staining.In clinical practice,we should be vigilant and carry out detailed differential diagnosis for suspected cases to avoid misdiagnosis and missed diagnosis.