子宫富细胞平滑肌瘤47例临床病理分析

Cellular leiomyoma of uterus clinicopathologic analysis of 47 cases.

目的研究子宫富细胞平滑肌瘤的临床及病理特征。方法分析了４７例子宫富细胞平滑肌瘤的临床及病理特征，并对其中３５例进行追踪随访。结果本病临床症状主要包括月经改变、贫血、疼痛、不孕等。术前诊断均为子宫肌瘤。术中所见符合子宫良性肿瘤特征，未见子宫外扩散或腹水。大体标本特征与普通的子宫肌瘤相似。病理组织学检查见部分区域肿瘤细胞丰富，排列紧密，但肿瘤细胞大小、形态仍较一致，核异形性少，每１０个高倍视野下核分裂相少于５个。治疗方法分别为行肌瘤剔出术、次全子宫或全子宫切除术。术后随访３５例，均存活至今。有５例术后肌瘤复发，其中４例为肌瘤剔出术后局部复发，１例为次全子宫切除术后宫颈残端复发。结论子宫富细胞平滑肌瘤是一种良性肿瘤，术后不必补充化疗或放疗，预后良好。

Objective To study the clinical and pathologic features of cellular leiomyoma of uterus.Methods 47 cases of cellular leiomyoma of uterus were analyzed,and 35 cases among them were followed up.Results The most common clinical symptoms were menorrhagia,anemia,pain and sterility.Preoperative diagnoses were all leiomymas of uterus.Intra-operative findings confirmed their benign features.Neither extra-uterine infiltration nor ascites was found.Macroscopic observations were similar to those of ordinary leiomyomas.Microscopic features were as follow increased density of tumorous cells in closely-arranged pattern in some areas,no atypia and rare mitoses(≤4/10HPF).Myomectomy,subtotal or total hysterectomy was performed respectively.35 cases were followed up,all of whom were still alive.Recurrence of myomas occurred in 5 cases,4 of which were of post-myomectomies and one case was residual recurrence in cervix uteri after subtotal hysterectomy.Conclusions Cellular leiomyomas of uterus were benign smooth muscle tumors.Post-operative chemotherapy or radiotherapy was not suggested,and its prognosis was good. \ \