子宫腺肉瘤15例临床病例分析

doi:10.6040/j.issn.1671-7554.0.2018.313

摘要/Abstract

摘要： 目的探讨子宫腺肉瘤(UA)患者的临床症状、诊断及治疗。方法回顾性分析2009年10月至2017年10月收治并病理确诊的15例UA患者临床资料,进行随访观察,并对相关文献进行复习。结果 15例患者主要临床症状为阴道不规则流血(12例,占80%)、下腹部疼痛、宫颈口脱出肿物等。其中宫颈腺肉瘤5例,伴肉瘤过度生长2例。根据2009年国际妇产科联盟(FIGO)分期标准:子宫颈腺肉瘤5例,其中ⅠB1期4例、ⅣB期1例;子宫体腺肉瘤10例,其中ⅠA期2例、ⅠB期4例、ⅠC期1例、ⅡA期1例、ⅢB期1例、ⅢC期1例。全部病例均行手术治疗,13例术后辅以化疗。随访4例因疾病进展死亡,1例因化疗后出现肺栓塞死亡,10例无进展生存。结论 UA是一种发病率较低的子宫肉瘤,患者症状、体征无特异性,易被误诊,常由术后病理检查及免疫组织化学确诊。该病常见于绝经后妇女,但也可见于年轻女性。虽然为低度恶性肿瘤,也应详细评估术后复发风险,尤其是合并肉瘤过度生长、深肌层浸润及伴有异源性分化的患者预后差。

关键词: 子宫腺肉瘤, 诊断, 治疗, 预后

Abstract: Objective To investigate the clinical symptoms, diagnosis and treatment of uterine adenosarcoma(UA). Methods The clinical data of 15 UA patients treated during Oct. 2009 and Oct. 2017 were retrospectively analyzed and related literatures were reviewed. Results Irregular vaginal bleeding was observed in 80% of cases. The other symptoms included lower abdominal pain, cervical spondylolysis and so on. The adenosarcoma was located on the cervix in 5 cases and 2 of them had sarcoma overgrowth. According to the FIGO stage(2009), of the 5 cervical adenosarcoma cases, 4 were ⅠB1, and 1 was ⅣB. Of the 10 uterine body adenosarcoma, 2 were ⅠA, 4 were ⅠB, and other 4 were ⅠC, ⅡA, ⅢB and ⅢC respectively. All 15 cases underwent surgical treatment, and 13 of them were treated with chemotherapy. During the follow-up, 4 patients died of disease progression, 1 died of pulmonary embolism after chemotherapy, and 10 survived progression-free. Conclusion UA is a rare disease. As the symptoms and signs are nonspecific, it can easily be misdiagnosed. Therefore, it needs to be differentiated from other benign and malignant lesions, and confirmed by postoperative pathological and immunohistochemical examinations. The disease generally occurs in postmenopausal women, but can also be found in young women. Although it is not malignant, the risk of postoperative recurrence should be evaluated carefully, especially in patients with sarcoma overgrowth, deep myometrial invasion and heterogenous differentiation.

Key words: Uterine adenosarcoma, Diagnosis, Treatment, Prognosis

中图分类号:

R737.33

夏雪薇,张贵宇,王立杰,张爱荣,王国云,姜洁,张师前,张辉,王文霞,崔保霞. 子宫腺肉瘤15例临床病例分析[J]. 山东大学学报 (医学版), 2018, 56(5): 64-69.

XIA Xuewei, ZHANG Guiyu, WANG Lijie, ZHANG Airong, WANG Guoyun, JIANG Jie, ZHANG Shiqian, ZHANG Hui, WANG Wenxia, CUI Baoxia. Uterine adenosarcoma: a study of 15 cases[J]. Journal of Shandong University (Health Sciences), 2018, 56(5): 64-69.

参考文献

[1] Nathenson MJ, Ravi V, Fleming N, et al. Uterine adenosarcoma: a review[J]. Curr Oncol Rep, 2016, 18(11): 68. doi:10.1007/s11912-016-0552-7.
[2] 梅又文, 李金科, 胡丽娜. 青年女性子宫腺肉瘤诊治[J]. 华西医学, 2011, 26(5): 717-719. MEI Youwen, LI Jinke, HU Lina. Diagnosis and treatment for uterine adenosarcoma in the young females[J]. West China Medical Journal, 2011, 26(5): 717-719.
[3] Krentel H, De Wilde RL. Submucous uterine adenosarcoma-minimally invasive treatment[J]. World J Surg Oncol, 2016, 14(1): 271. doi:10.1186/s12957-016-1015-1.
[4] Chin PS, Chia YN, Lim YK, et al. Diagnosis and management of Mullerian adenosarcoma of the uterine cervix[J]. Int J Gynaecol Obstet, 2013, 121(3): 229-232.
[5] Pinto A, Howitt B. Uterine adenosarcoma[J]. Arch Pathol Lab Med, 2016, 140(3): 286-290.
[6] Krivak TC, Seidman JD, McBroom JW, et al. Uterine adenosarcoma with sarcomatous overgrowth versus uterine carcinosarcoma: comparison of treatment and survival[J]. Gynecol Oncol, 2001, 83(1): 89-94.
[7] Clement PB, Scully RE. Mullerian adenosarcoma of the uterus: a clinicopathologic analysis of 100 cases with a review of the literature[J]. Hum Pathol, 1990, 21(4): 363-381.
[8] Fleming NA, Hopkins L, de Nanassy J, et al. Mullerian adenosarcoma of the cervix in a 10-year-old girl: case report and review of the literature[J]. J Pediatr Adolesc Gynecol, 2009, 22(4): e45-51.
[9] 刘强, 张成军, 石文达, 等. 子宫腺肉瘤的CT、MR表现[J]. 中国介入影像与治疗学, 2015, 7(12): 419-422. LIU Qiang, ZHANG Chengjun, SHI Wenda, et al. CT and MR manifestations of uterine adenosarcoma[J]. Chinese Journal of Interventional Imaging & Therapy, 2015, 7(12): 419-422.
[10] Chourmouzi D, Boulogianni G, Zarampoukas T, et al. Sonography and MRI of tamoxifen-associated mullerian adenosarcoma of the uterus[J]. AJR Am J Roentgenol, 2003, 181(6): 1673-1675.
[11] Yoshizako T, Wada A, Kitagaki H, et al. MR imaging of uterine adenosarcoma: case report and literature review[J]. Magn Reson Med Sci, 2011, 10(4): 251-254.
[12] Leung F, Terzibachian JJ, Aouar Z, et al. Uterine sarcomas: clinical and histopathological aspects. Report on 15 cases[J]. Gynecol Obstet Fertil, 2008, 36(6): 628-635.
[13] Stern RC, Dash R, Bentley RC, et al. Malignancy in endometriosis: frequency and comparison of ovarian and extraovarian types[J]. Int J Gynecol Pathol, 2001, 20(2): 133-139.
[14] Yang C, Oh HK, Kim D. Mullerian adenosarcoma arising from rectal endometriosis[J]. Ann Coloproctol, 2014, 30(5): 232-236.
[15] Akhavan A, Akhavan Tafti M, Aghili F, et al. Uterine adenosarcoma in a patient with history of breast cancer and long-term tamoxifen consumption[J]. BMJ Case Rep, 2012, 2012. doi: 10.1136/bcr-2012-006590.
[16] Lai CR, Hsu CY, Li AF. Uterine adenosarcoma detected by conventional papanicolaou smear: a case report with emphasis on integrating the immunocytochemical staining[J]. Diagn Cytopathol, 2012, 40(10): 920-924.
[17] Carroll A, Ramirez PT, Westin SN, et al. Uterine adenosarcoma: an analysis on management, outcomes, and risk factors for recurrence[J]. Gynecol Oncol, 2014, 135(3): 455-461.
[18] Lee YJ, Kim DY, Suh DS, et al. Feasibility of uterine preservation in the management of early-stage uterine adenosarcomas: a single institute experience[J]. World J Surg Oncol, 2017, 15(1): 87-91.
[19] Ozmen B, Uzum N, Unlu C, et al. Surgical conservation of both ovaries in an adolescent with uterine mullerian adenosarcoma: a case report[J]. J Minim Invasive Gynecol, 2007, 14(3): 375-378.
[20] Koh WJ, Greer BE, Abu-Rustum NR, et al. Uterine sarcoma, version 1.2016: featured updates to the NCCN guidelines[J]. J Natl Compr Canc Netw, 2015, 13(11): 1321-1331.
[21] Machida H, Nathenson MJ, Takiuchi T, et al. Significance of lymph node metastasis on survival of women with uterine adenosarcoma[J]. Gynecol Oncol, 2017, 144(3): 524-530.
[22] Tanner EJ, Toussaint T, Leitao MM, et al. Management of uterine adenosarcomas with and without sarcomatous overgrowth[J]. Gynecol Oncol, 2013, 129(1): 140-144.
[23] Arend R, Bagaria M, Lewin SN, et al. Long-term outcome and natural history of uterine adenosarcomas[J]. Gynecol Oncol, 2010, 119(2): 305-308.
[24] Bernard B, Clarke BA, Malowany JI, et al. Uterine adenosarcomas: a dual-institution update on staging, prognosis and survival[J]. Gynecol Oncol, 2013, 131(3): 634-639.
[25] Yamagami W, Susumu N, Ninomiya T, et al. A retrospective study on combination therapy with ifosfamide, adriamycin and cisplatin for progressive or recurrent uterine sarcoma[J]. Mol Clin Oncol, 2014, 2(4): 591-595.
[26] Verschraegen CF, Arias-Pulido H, Lee SJ, et al. Phase IB study of the combination of docetaxel, gemcitabine, and bevacizumab in patients with advanced or recurrent soft tissue sarcoma: the Axtell regimen[J]. Ann Oncol, 2012, 23(3): 785-790.
[27] Reed NS, Mangioni C, Malmstrom H, et al. Phase III randomised study to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stages I and II: an european organisation for research and treatment of cancer gynaecological cancer group study(protocol 55874)[J]. Eur J Cancer, 2008, 44(6): 808-818.
[28] Seagle BL, Kanis M, Strohl AE, et al. Survival of women with Mullerian adenosarcoma: a National Cancer Data Base study[J]. Gynecol Oncol, 2016, 143(3): 636-641.

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