女性生殖系统恶性中胚叶混合瘤22例临床特征分析

Clinical analysis of 22 cases of malignant mixed mesodermal tumors of the female reproductive system

目的探讨女性生殖系统恶性中胚叶混合瘤(malignant mixed mesodermal tumors,MMMTs的临床特点、诊治难点及预后。方法回顾性分析2010年6月年至2017年6月南京大学医学院附属鼓楼医院妇科收治的经病理确诊的22例生殖系统MMMTs患者的临床资料。结果 22例患者中,子宫体MMMTs15例,输卵管卵巢MMMTs6例,宫颈MMMTs1例。子宫体MMMTs主要表现为异常阴道出血、排液;输卵管卵巢MMMTs主要表现为腹痛、盆腔包块;53.3%(8/15)的子宫体MMMTs在相对早期诊治,但首次病理诊断的准确率仅31.8%(7/22),95.5%(21/22)的患者分别接受了1~2次肿瘤切除手术。其中临床病理分期Ⅰ期患者10例,中位生存时间为33个月;Ⅲ期患者10例,中位生存时间为14个月;Ⅳ期患者1例,术后11个月复发,术后22个月死亡。结论恶性中胚叶混合瘤多发于围绝经期和绝经后妇女,恶性程度高,死亡率高,需制定个体化的综合治疗方案。

Objective To investigate the clinical characteristics,difficulties in diagnosis and treatment,and the prognosis of malignant mixed mesodermal tumor(MMMTs)of the female reproductive system.Methods The clinical data of the 22 patients with MMMTs in Nanjing Drum Tower Hospital from June 2010 to June 2017 were analyzed.Results 15 cases of uterine MMMTs,6 cases of tubal ovarian MMMTs,1 cases of cervical MMMTs were included.Uterine MMMTs mainly represent abnormal vaginal bleeding and drainage.Tubal ovarian MMMTs mainly represent abdominal pain and pelvic mass.53.3%(8/15)uterine MMMTs were relatively early diagnosed and treated,but the accuracy of the first pathological diagnosis was 31.8%(7/22).Once or twice operations were performed in 95.5%(21/22)of the patients.10 patients in stage I,with a median survival time of 33 months and 10 patients in stageⅢ,with a median survival time of 14 months.One patient in stageⅣ,with a recurrence in 11 months and died 22 months after operation.Conclusion MMMTs occurred in perimenopausal and postmenopausal women,with high degree of malignancy and high mortality rate,and comprehensive individualized treatment were needed.