“子宫肌瘤”术后病理证实子宫恶性肿瘤32例临床特点及诊疗分析  

Clinical characteristics and diagnosis and treatment analysis of 32 cases of malignant uterine tumors confirmed by postoperative pathology of"uterine fibroids"

作　　者：李琳[1] 郭银树[1] Li Lin;Guo Yinshu(Gynecological Minimal Invasive Center,Beijing Obstetrics and Gynecology Hospital,Capital Medical University/Bejing Maternal and Child Health Care Hospital,Beijing 100006,P.R.China)

机构地区：[1]首都医科大学附属北京妇产医院/北京妇幼保健院妇科微创中心,北京100006

出　　处：《中国计划生育和妇产科》2024年第8期71-75,共5页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的分析术前误诊为“子宫肌瘤”的子宫恶性肿瘤患者临床资料,总结经验以提高术前诊断率。方法回顾性分析2018年1月至2023年12月首都医科大学附属北京妇产医院收治的因“子宫肌瘤”行手术治疗,术中或术后发现子宫恶性肿瘤的32例患者的临床资料。结果32例患者平均发病年龄(50.6±7.6)岁;临床症状出现异常子宫出血16例(50.00%),出现尿频便秘等压迫症状6例(18.75%),自触及下腹包块2例(6.25%),体检发现“子宫肌瘤”8例(25.00%);病程平均(16±5)月。超声或磁共振提示最大结节平均直径为(10.5±4.5)cm。超声下主要表现为子宫增大、内含回声不均的实性肿块,有时可见不规则囊性区、肿块周边或内部血流丰富。磁共振提示T1呈等信号,T2呈高信号,增强扫描明显不均匀强化,边界不清。术后病理为子宫平滑肌肉瘤12例,上皮样平滑肌肉瘤2例,子宫内膜间质肉瘤11例,腺肉瘤5例,癌肉瘤1例,恶性间叶瘤1例。32例患者术前均因“子宫肌瘤”接受手术治疗,“子宫肌瘤”切除术12例,全子宫切除术20例,二次补充手术14例,术后辅以放疗或化疗1例。术后复发2例,截至2024年5月无死亡病例。结论术前误诊为子宫肌瘤的子宫恶性肿瘤主要是子宫肉瘤,很难在术前明确诊断。如患者有异常子宫出血症状,应积极行内膜活检取样。如为绝经后患者、有恶性肿瘤发病高危因素、术前超声或磁共振提示肿瘤回声不均匀、边界不清、血运丰富者需引起警惕,必要时需请放射科医生会诊再次共同阅片,谨慎选择手术方式及入路,术中应仔细剖视标本,及时送冰冻病理检查。Objective To analyze the clinical data of patients with uterine malignant tumors who were misdiagnosed as uterine fibroids before surgery,and to summarize the experience in order to improve the preoperative diagnostic rate.Methods Retrospective analysis of clinical data of 32 patients admitted to Beijing Obstetrics and Gynecology Hospital,Capital Medical University from January 2018 to December 2023 who underwent surgical treatment for uterine fibroids and were found to have uterine malignant tumors during or after surgery.Results The average age of onset of 32 patients was(50.6±7.6)years old,16 cases(50.00%)had abnormal uterine bleeding,6 cases(18.75%)had compression symptoms such as frequent urination and constipation,2 cases(6.25%)had palpable lower abdominal masses,and 8 cases(25.00%)had uterine fibroids during physical examination;the average course of disease was(16±5)months.The average maximum nodule was(10.5±4.5)cm.The main ultrasound manifestation was a solid mass with enlarged uterus and uneven echogenicity,sometimes with irregular cystic areas,abundant blood flow around or inside the mass.The MRI indicates that T1 showed equal signal,T2 showed high signal,and the enhanced scan showed obvious uneven enhancement with unclear boundaries.Postoperative pathology showed 12 cases of uterine leiomyosarcoma,2 cases of epithelioid leiomyosarcoma,11 cases of endometrial stromal sarcoma,5 cases of adenosarcoma,1 case of carcinosarcoma,and 1 case of malignant stromal tumor.32 patients underwent surgical treatment for"uterine fibroids",including 12 cases of myomectomy,20 cases of total hysterectomy,14 cases of secondary supplementary surgery,and 1 case of postoperative adjuvant radiotherapy or chemotherapy.There were 2 cases of postoperative recurrence and no deaths as of May 2024.Conclusions The malignant tumor of the uterus misdiagnosed as uterine fibroids before surgery is mainly uterine sarcoma.It is difficult to make a clear diagnosis before surgery.If the patient has symptoms of abnormal uterine bleeding,en

关 键 词：子宫肌瘤 子宫肉瘤 恶性肿瘤 

分 类 号：R737.33[医药卫生—肿瘤]