子宫内膜间质肉瘤(ESS)的临床和病理特点及超声结果  

Analysis of clinical and pathological characteristics and ultrasound results of endometrial stromal sarcoma(ESS)

作　　者：蔡琪 张浩 任芸芸 CAI Qi;ZHANG Hao;REN Yun-yun(Department of Ultrasound,Obstetrics and Gynecology Hospital,Fudan University,Shanghai 200011,China)

机构地区：[1]复旦大学附属妇产科医院超声科,上海200011

出　　处：《复旦学报（医学版）》2018年第6期835-839,845,共6页Fudan University Journal of Medical Sciences

摘　　要：目的探讨子宫内膜间质肉瘤(endometrial stromal sarcoma,ESS)的临床和病理特点及对超声结果进行分析,以提高对ESS的超声检出率。方法回顾性分析复旦大学附属妇产科医院2010年1月至2016年12月78例经手术病理检查证实为ESS患者的临床和病理特点及超声结果分析。结果78例患者平均年龄为(44.3±10.9)岁。主要临床表现:46例(59.0%)因体检发现异常占位就诊,28例(35.9%)因异常阴道流血就诊,4例(5.1%)因腹痛就诊。术前超声正确诊断4例(5.1%),误诊为子宫肌瘤伴变性24例(30.8%),子宫肌瘤22例(28.2%),子宫腺肌症10例(12.8%),宫腔息肉5例(6.4%),肌瘤影响宫腔5例(6.4%),卵巢肿瘤4例(5.1%),肌瘤伴腺肌症3例(3.8%),子宫内膜癌1例(1.4%)。ESS的超声表现:病灶多为单发,位置各异,可位于肌壁间或宫腔,较大时宫腔及肌壁间均可累及,也可位于盆腔。病灶回声多呈中低回声或内部回声不均质,CDFI示病灶大多为条索状血流信号(44例)、星点状血流信号(21例),彩色血流不明显(13例)。术后病理检查均证实为ESS,72例(92%)低级别子宫内膜间质肉瘤(low-grade endometrial stromal sarcoma,LGESS),其中6例LGESS伴性索样分化、7例LGESS伴平滑肌分化,4例为高级别子宫内膜间质肉瘤(high-grade endometrial stromal sarcoma,HGESS),2例为未分化子宫肉瘤(undifferentiated uterine sarcoma,UUS),其中1例USS伴性索样分化。结论 ESS临床及超声表现无特异性,需要病理诊断确诊。当超声发现肌壁内病灶边界不清,内部回声不均质,弥漫性子宫肌层增厚,内部回声伴有结节性,从宫腔延伸至子宫肌层的息肉样结构等情况时,检查者应充分考虑ESS的可能性,并在术前予以提示,帮助临床在术前做好充分的准备,降低二次手术的发生率。Objective To investigate the clinical and pathological characteristics and ultrasound results of the endometrial stromal sarcoma(ESS),in order to improve the ultrasound detection rate.Methods The clinical data and ultrasonographic manifestations of 78 cases of endometrial stromal sarcoma proved by operation and pathology in Obstetrics and Gynecology Hospital of Fudan University from Jan.,2010 to Dec.,2016 were retrospectively analyzed. Results The average age of the 78 patients was(44.3±10.9)years old.The most common symptom of uterine ESS was abnormal mass revealed in routine examination(46 cases,59.0%),but some patients(28 cases,35.9%)presented with vaginal bleeding or pelvic pain(4 cases,5.1%).Before operation,only 4 cases(5.1%)were accurately diagnosed with ultrasonography.The cases of misdiagnosis by ultrasonography included 24 cases(30.8%)of uterine leiomyoma with degeneration,22 cases(28.2%)of uterine leiomyoma,10 cases(12.8%)of adenomyosis,5 cases(6.4%)of uterine polyps,5 cases(6.4%)of uterine leiomyoma which affected the uterine cavity,4 cases(5.1%)of ovarian tumor,3 cases(3.8%)of uterine leiomyoma with adenomyosis and 1 case(1.4%)of endometrial cancer.Ultrasound performance:most of the lesions were single at different locations,located in the myometrial or endometrial cavity;endometrial cavity and myometrial were involved in larger lesions;they could also be located in the pelvic.Most of the lesions were hypoechoic or heterogeneous echogenicity.CDFI:Funicular blood flow signal was detected in44 cases,star punctiform blood flow signal was found in21 cases,and no blood flow signal was found in13 cases.Pathology diagnosis:there were 72 cases of lowgrade endometrial stromal sarcoma(LGESS),of which 6 cases of LGESS with sex cord-like differentiation and 7 cases with smooth muscle differentiation;4 cases of high-grade endometrial stromal sarcoma(HGESS)and 2 cases of undifferentiated uterine sarcoma(UUS),of which 1 case of UUS with sex cord-like differentiation. Conclusions ESS is an uncommon uterine mesenchy

关 键 词：子宫内膜间质肉瘤(ESS) 子宫 超声检查 病理学 

分 类 号：R711.74[医药卫生—妇产科学]