原发性男性生殖系统平滑肌肿瘤5例报告并文献复习

Primary smooth muscle tumor in the male reproductive system: A report of 5 cases and review of the literature

目的:总结男性生殖系统平滑肌肿瘤的临床诊疗信息。方法:收集1992～2012年间我院5例原发性男性生殖系统平滑肌肿瘤患者的超声检查资料、病理检查结果以及治疗方法和术后随访资料,并结合文献加以分析。结果:与平滑肌瘤相比,平滑肌肉瘤超声下回声混杂,强于睾丸,血供更加丰富,HE染色可见明显的核分裂相(≥2/10HP),免疫组化染色可见HIF-1α(+)和Glut-1(+)。2例平滑肌瘤接受了单纯肿块切除术,最长随访10年,未见复发。另外3例平滑肌肉瘤均接受了根治性切除术,术后未联合放化疗,最长随访满1年,未见复发转移。结论:原发性男性生殖系统平滑肌肿瘤术前明确诊断困难,对超声提示恶性可能者,要重视术前MRI检查以明确有无淋巴结转移,重视术中快速冰冻检查。对于病理确诊为平滑肌肉瘤者,是否在术后联合放化疗,应谨慎选择。

Objective： To systematically study the clinical diagnosis and treatment of smooth muscle tumor in the male reproductive system. Methods： We analyzed the ultrasonographic features, pathological findings, treatment strategies and postoperative follow-up results of 5 male patients with smooth muscle tumor in the reproductive system, and reviewed other relevant literature. Resuits： Compared with leiomyoma, leiomyosarcoma exhibited stronger mixed echoes than the testis at uhrasonography, typical mitotic phase （ ≥2/10 HP） of tumor cells at HE staining, and significant expressions of HIF-lct and Glut-1 at immunohistochemistry. No relapse was observed in the 2 cases of leiomyoma during the lO-year follow-up after simple tumor resection, nor were recurrence and metastasis in another 3 cases of leiomyosareoma during the first year after radical surgery without combined radio- and chemo-therapy. Conclusion： Primary smooth muscle tumor of the male reproductive system is difficult to be diagnosed. Uhrasonography can help to preliminarily screen leiomyosarcoma. For those with possible leiomyosarcoma, preoperative MRI and intraoperative frozen sectioning examinations are recommended for the possibility of lymphatic metastasis. Postoperative radiotherapy and chemotherapy should be chosen cautiously for those confirmed with leiomyosarcoma by pathological examination.