子宫平滑肌肉瘤16例临床分析

16 Cases Reports of Uterine Leiomyosarcoma

目的:探讨子宫平滑肌肉瘤(LMS)的临床病理特征,以期对该病的诊治提供帮助。方法:回顾性分析16例LMS患者的临床表现、病理特点及诊治情况。结果:LMS占子宫肉瘤的31.4%(16/51),平均发病年龄为52岁。16例中阴道不规则流血4例,腹部胀痛5例,盆腔包块8例。包块平均直径约7.5cm,3例包块内部血流阻力指数平均0.35。病理分期Ⅰ期12例。显微镜下见肿瘤细胞有程度不等的异型性,7例可见凝固性坏死。6例检测平滑肌肌动蛋白(SMA)5例为阳性;7例检测细胞增殖标记(Ki-67)的表达,均大于5%。术前仅1例因活检脱出的宫颈内容物而诊断为平滑肌肉瘤,其余经术后病理检查确诊。所有患者均手术治疗,12例辅以化疗。13例随访病例中3例死亡,1例复发。结论:子宫平滑肌肉瘤临床表现多样,以盆腔包块为主。肿瘤细胞有不同程度异型性,可见凝固性坏死。术前诊断困难,术后病理检查为确诊手段,免疫组化检测有助于诊断。病理分期低的患者经积极手术并辅以化疗,预后较好。

Objective：To investigate the clinical,histopathological features of uterine leiomyosarcoma for improvement of its diagnosis and treatment. Methods：Clinical and histopathological features,treatments of 16 cases diagnosed as uterine leiomyosarcoma were retrospectively analyzed. Results：Uterine leiomyosarcoma accounted for 31.4% of all uterine sarcoma in our hospital. The mean onset age was 52 years. Of the 16 cases,4 patients had irregular vaginal bleeding,5 patients had abdominal pain,8 patients were found pelvic mass. The mean tumor size was 7.5 cm,while the mean blood flow resistance index of 3 patients was 0.35. There were 12 cases of stage I. Varing degrees of atypia was seen in all cases,and coagulation necrosis was seen in 7 cases under microscope. As for immunohistochemical test, smooth muscle actin were tested in 6 cases,of which 5 cases was positive,while Ki-67 was positive in all 7 cases tested. Only one case was diagnosed as LMS because biopsy of tissue from uterine was made. 3 cases were misdiagnosed as hysteromyom,1 case was misdiagnosed as oophoroma. All cases were diagnosed definitly by pathologic test. All of them undertook operative treatment,of which 12 had chemo-treatment. 13 cases were followed-up,of which 3patients had died and 1 patient had recurrence of the disease. Conclusions：Clinical features of LMS are varied,the main symptom was pelvic mass. Varing degrees of atypia and coagulation necrosis are seen in tumor cells under microscope. It is difficult to make a definite diagnosis before operation. Pathologic examination is the definite diagnosis method, and immunohistochemical test is helpful for its diagnosis. The prognosis of uterine leiomyosarcoma can be improved if the patients can be diagnosed in early stage and be treated by operation and chemicotherapy timely.