未婚年轻女性子宫内膜腺肉瘤:1例报道及文献回顾  

Endometrial adenosarcoma in unmarried young women: A case report and literature review

作　　者：李敏[1] 郭维纳[1] 沈怡[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院妇产科,武汉湖北430022

出　　处：《肿瘤》2016年第5期581-584,共4页Tumor

摘　　要：目的 :探讨子宫内膜腺肉瘤的诊治方法,以期提高对子宫内膜腺肉瘤的认识。方法 :分析了1例子宫内膜腺肉瘤未婚年轻女性患者的诊治过程及临床资料,并对相关文献进行复习。结果 :1例19岁的子宫内膜腺肉瘤未婚年轻女性因不规则阴道出血就诊,该例患者无性生活史。妇科检查见处女膜口有异物脱出,直肠彩超发现宫腔内有异常肿块影。血清肿瘤标志物检查均为阴性。探查术中发现左侧卵巢和道格拉斯腔内转移,遂行全子宫切除+双侧附件切除+盆腔淋巴结清扫术。术后病理学结果为子宫肉瘤(腺肉瘤),盆腔淋巴结无转移。术后给予化疗和高效孕激素治疗。术后4个月盆腔肿瘤复发,与周围组织黏连严重,无法手术,遂行PAC方案(异环磷酰胺、多柔比星、卡铂)化疗。化疗28 d后,复发肿瘤持续增大,遂行手术治疗。结论 :子宫内膜腺肉瘤发病率极低,临床上常常表现为不规则阴道出血和息肉样肿物,易被误诊;该病常见于绝经后期妇女,但也可见于年轻女性;尽管表现为低度恶性,但易于复发。Objective： To explore the diagnosis and treatment of endometrial adenosarcoma, in order to improve the understanding of this rare disease.Methods： The clinical information of diagnosis and treatment of one case of endometrial adenosarcoma who was an unmarried young female without sexual behavior was analyzed, and the related literatures were reviewed.Results： A 19-year-old unmarried female who had no sexual behavior and suffered from irregular vaginal bleeding was diagnosed of endometrial adenosarcoma. The preoperative gynecological examination found a mass prolapsed out of the hymen. The transrectal ultrasound showed a mass in uterine cavity. The serum tumor markers were all negative. During the operation, the operator found the metastatic neoplasms in the left ovary and Douglas cavity, then performed total hysterectomy, bilateral accessory resection and pelvic lymph node dissection. Pathological sections of the uterine neoplasms confirmed it was endometrial adenosarcoma, but the pelvic lymph nodes were negative. After operation, the adjuvant chemotherapy and high-dose progesterone therapy were administered. Four months after operation, the patient had relapsed tumor and received chemotherapy with PAC regimen （ifosfamide, doxorubicin and carboplatin）, but the size of the relapsed mass increased continuously, then the surgical operation was performed again. Conclusion： The endometrial adenosarcoma is a rare tumor which always presents with irregular vaginal bleeding and polypoid lesions and is often misdiagnosed. This disease is commonly seen in postmenopausal women, but it is also seen in young women. Although endometrial adenosarcoma has a low-grade malignant potential, it is easy to relapse.

关 键 词：子宫内膜腺肉瘤 年轻女性 未婚 复发 二次手术 

分 类 号：R737.3[医药卫生—肿瘤]