输卵管癌肉瘤7例分析并文献复习

Analysis of 7 cases of fallopian tube carcinosarcoma and literature review

背景与目的:输卵管癌肉瘤是非常罕见的恶性肿瘤,易转移和复发,预后差。旨在回顾性分析输卵管癌肉瘤的临床表现、组织病理学、治疗和预后,并对既往相关文献进行复习。方法:回顾性分析7例输卵管癌肉瘤患者的临床表现、病理特点和治疗方式,随访生存时间,并复习相关文献。结果:7例输卵管癌肉瘤患者,最常见症状为阴道不规则流血(4/7,57.1%)。病理Ⅰa期1例,Ⅱa期1例,Ⅱb期1例,Ⅲb期l例,Ⅲc期3例。异源性4例(57.1%),均见软骨成分,同源性3例(42.9%)。7例均行瘤体减灭术,6例接受化疗,无放疗病例。存活5例,死亡2例。生存时间超过5年的有3例,最长的至末次随访已存活9年零6个月。结论:病理检查为输卵管癌肉瘤的确诊手段。病理同源性间质成分预后优于异源性间质成分。满意的瘤体减灭术,术后给予足够疗程的TP方案化疗,且全身静脉化疗联合局部腹腔灌注化疗可能是治疗输卵管癌肉瘤的有效治疗方法。

Background and purpose： Fallopian tube carcinosarcoma is a rare malignant tumor that is prone to metastasis and recurrence. Patients with the malignancy often have poor prognosis. This paper retrospectively analyzed the clinical manifestation, pathology, treatment and prognosis of fallopian tube Methods： The clinical manifestations, pathological features, treatment and survival time of 7 cases of fallopian tube carcinosarcoma were retrospectively analyzed. Results： The most common symptoms of 7 cases of fallopian tube carcinosarcoma were irregular vaginal bleeding （4/7, 57.1%）. Among 7 cases, one case was stage I a, 1 stage Ⅱa, 1 stage lib, 1 stage lllb, and 3 stage lllc. Four cases （57.1%） were heterologous and found to have cartilage components whereas 3 cases （42.9%） were homologous. Seven cases were performed with tumor volume reduction surgery, and 6 cases with chemotherapy, while no one received radiotherapy. Five patients survived and 2 were dead. The survival time of 3 patients was more than 5 years. The longest survival time to the end of the follow-up was 114 months. Conclusion： The pathological examination is the diagnostic means of fallopian tube carcinosarcoma. The prognosis of the patients with the pathological characteristics of the homologous is better than that of the heterologous. Satisfactory reduction of tumor, postoperative chemotherapy with adequate TP regimen, combined with systemic chemotherapy and intraperitoneal chemotherapy may be an effective treatment for fallopian tube carcinosarcoma.