5例子宫腺肉瘤病例分析及文献复习

Clinical analysis on 5 cases of uterine adenosarcoma and literature review

目的探讨子宫腺肉瘤患者的临床特征、病理特点、治疗及预后。方法回顾性分析5例子宫腺肉瘤患者的临床资料。5例子宫腺肉瘤患者的年龄为15～70岁,中位年龄为58岁,临床表现为阴道出血及下腹部包块。2例绝经患者绝经前有子宫内膜异位症病史。5例患者均接受手术治疗,其中4例绝经患者行全子宫+双附件切除术;1例患者的年龄为15岁,保留卵巢,行全子宫+双侧输卵管切除术。统计并分析子宫腺肉瘤患者的临床特征、病理特点、病理高危因素、主要辅助检查情况及治疗方案。结果 3例患者术前行血清乳酸脱氢酶(LDH)检测,结果均﹥200 IU/L。5例患者术前行B超检查,均提示宫腔或宫颈肿物,直径为5～10 cm。5例患者术后病理均存在特征性"袖口"状结构,其中2例患者有深肌层侵犯,2例患者有肿瘤细胞异源性分化,4例患者存在高危因素。术后补充吉西他滨+多西他赛方案化疗,5例患者除1例失访外均未复发。结论子宫腺肉瘤的发病以绝经后女性多见,亦见于青少年女性,无特异性临床特征,治疗以全子宫+双附件切除为主,术后化疗可能减少复发。

Objective To explore the clinical characteristics, pathological features, treatment and prognosis of uterine adenosarcoma. Method Retrospective analysis was performed for 5 cases of uterine adenosarcoma to evaluate their clinical data. The median age of the 5 cases of uterine adenosarcoma was 58 years old (15-70 years old), with clinical manifestations of vaginal bleeding and lower abdominal mass. Two patients had previous endometriosis. All 5 patients received surgical treatment, among them, 4 were administered with total hysterectomy and bilateral salpingo-oophorectomy, and another one at 15 years old was given ovary-sparing total hysterectomy with bilateral salpingectomy. The clinical characteristics, pathological features, pathological risk factors, adjuvant examinations and treatment plan of these uterine adenosarcoma were investigated. Result Serum lactate dehydrogenase was detected in 3 patients before operation, and the results were > 200 IU/L. All patients underwent preoperative B-ultrasonography which indicated uterine or cervical mass, of which the diameter was 5-10 cm. The 5 cases were observed with the characteristic sign of Codman’s triangle, and 2 of them had deep muscle invasion, and 2 cases showed heterogeneous differentiation of tumor cells, and 4 cases were with high risk factors. Gemcitabine + docetaxel chemotherapy was added after surgery, the 5 patients, except 1 that lost follow up, survived so far and no recurrence occurred. Conclusion Uterine adenosarcoma is relatively common in postmenopausal women, while may also occur in young women, with specific clinical manifestations, the main treatment option should be total hysterectomy with bilateral salpingo-oophorectomy, in addition, postoperative chemotherapy may reduce the recurrence rate.