育龄期子宫肉瘤误诊为子宫肌瘤变性1例及文献复习  

Uterine sarcoma misdiagnosed as degeneration of myoma in a patient with reproductive age and literatures review

作　　者：吕炜[1] 邓姗[2] 

机构地区：[1]内蒙古包头市中心医院,包头014040 [2]中国医学科学院,北京协和医学院,北京协和医院妇产科,100730

出　　处：《生殖医学杂志》2017年第9期915-920,共6页Journal of Reproductive Medicine

摘　　要：目的报道1例以"间断发热"为主要表现的育龄期子宫肉瘤病例,并结合文献复习对临床处理提出警示。方法病例报告附文献复习。结果 35岁育龄期女性,间断发热2月余,感染内科全面排查未发现明确病原体,盆腔增强MRI提示子宫多发肌瘤变性,最大肌瘤结节位于子宫后壁,大小约60.9mm×60.5mm×96.7mm。因患者有生育要求,第1次手术行开腹肌瘤剔除术,术后病理提示中分化子宫平滑肌肉瘤,再次行腹腔镜下全子宫+双附件切除+盆腔淋巴结清扫术。术后病理为子宫平滑肌肉瘤,侵及左侧宫旁组织。术后分期ⅡB期,辅以顺铂-表阿霉素-异环磷酰胺(PEI)化疗中。子宫肉瘤是比较罕见的疾病,因缺乏特异性症状和体征,没有敏感的肿瘤标志物,影像学诊断特异性不高,术前诊断较为困难。子宫肉瘤及子宫肌瘤的临床表现及影像学相似,但两者的手术范围、生存率、复发率等截然不同。结论尽管存在一定困难,仍应结合病史、临床表现、体征、辅助检查、术中情况等各个环节争取对子宫肉瘤实现早期鉴别诊断。Objective： To report a medical record of a patients with uterine sarcoma in reproductive age,and provide a warning for clinical treatment.Methods： The medical record was reported and the literatures were reviewed.Results： The 35 years old woman presented with multiple fibroids and intermittent fever for more than 2 months.An overall investigation of infection in internal medicine did not identify the specific pathogen.Degeneration of myoma was suspected by pelvic enhanced MRI.The size of biggest fibroid nodule was 60.9mm×60.5mm×96.7mm.In order to preserve fertility desirability,transabdominal myomectomy was done in the first stage,however,the pathological result turned out to be uterine leiomyosarcoma.Total hysterectomy and bilateral adnexectomy and pelvic lymphadenectomy were done in the second stage.Postoperative pathology results showed uterine leiomyosarcoma,and invaded the left side of the uterine surrounding tissue.The surgical staging was ⅡB,chemotherapy with cisplatinum,epirubicin and ifosfamide was followed.Uterine sarcoma is a rare malignant tumor.Preoperative diagnosis is difficult due to unspecific signs and symptoms,lack of sensitive tumor marker or specific imaging test.Postoperative pathological examination is the golden standard.The uterine sarcoma is similar to uterine myoma in clinical and imaging findings,but the scope of operation,survival rate and recurrence rate are significantly different.Conclusions：It is crucial to make the best early diagnosis from patient history,physical examination,laboratory test,and imaging studies despite the difficulties,all which can offer supports for surgery.

关 键 词：子宫肉瘤 子宫肌瘤 鉴别诊断 预后 

分 类 号：R[医药卫生]