女性生殖道同期发生的黏液性上皮化生和肿瘤14例分析

Clinical analysis of 14 cases of synchronous mucinous metaplasia and neoplasia of the female genital tract

目的探讨女性生殖道同期发生的黏液性上皮化生和肿瘤(synchronous mucinous metaplasia and neoplasia of the female genital tract,SMMN-FGT)的临床表现、病理特征、诊治方法及预后。方法回顾性分析2014年10月至2020年4月复旦大学附属妇产科医院诊断的14例SMMN-FGT患者的临床资料和随访记录。结果发病中位年龄为46岁(33~70岁),初发症状主要为阴道排液(8/14)及卵巢囊肿(4/14)。所有行HPV检查的患者(13/14)结果均为阴性。所有患者均接受手术治疗,其中7例行全子宫+双附件切除术,4例行广泛全子宫+双附件切除术+盆腔淋巴结清扫术,3例行全子宫+双侧输卵管切除术,保留卵巢。术后病理提示14例病变累及子宫内膜,13例累及宫颈,9例累及输卵管,9例累及卵巢,7例同时累及宫颈、子宫内膜,输卵管及卵巢。8例患者进展为恶性肿瘤,术后接受辅助治疗。随访14~80个月,1例因复发死亡,13例继续随访中。结论SMMN-FGT是一组同时累及女性生殖道多个部位的黏液性病变,阴道排液多为其首发症状,其宫颈病变与HPV感染无关。治疗以手术为主,合并恶性病变患者须行辅助治疗,预后有待进一步随访。

Objective To investigate the clinical and pathological features,diagnosis,therapeutic and prognosis of synchronous mucinous metaplasia and neoplasia of the female genital tract(SMMN-FGT).Methods Clinical and follow-up data of 14 cases of SMMN-FGT diagnosed from Oct 2014 to Apr 2020 in the Obstetrics and Gynecology Hospital of Fudan University were retrospectively collected and analyzed.Results The patients were aged 33 to 70 years old(median 46 years old).The first symptoms were vaginal discharge(8/14)and ovarian cyst(4/14).HPV-negative results were found for all patients who underwent this test(13/14).All patients received surgical treatment,including total hysterectomy and bilateral adnexal resection in 7 cases;extensive total hysterectomy and bilateral adnexal resection and pelvic lymph node dissection in 4 cases;total hysterectomy and bilateral salpingectomy with ovarian preservation in 3 cases.The postoperative pathology showed involvement of the endometrium in 14 cases,of the cervix in 13 cases,of the fallopian tubes in 9 cases and of the ovaries in 9 cases.In 7 cases,lesions were seen in all organs of the female reproductive system(cervix,uterus,fallopian tubes and ovaries).Eight cases were diagnosed with malignant disease,and all of them received adjuvant therapy.All the patients were followed up for 14 to 80 months,and only 1 case was dead of recurrent disease.Conclusion SMMN-FGT is a series of mucinous lesions involving multiple areas of the female genital tract simultaneously.Abnormal vaginal discharge is the initial symptom.There was no association of cervical HPV-infection.Complete surgical resection remains the mainstay treatment.Patients who combined with malignant lesions require adjuvant therapy and continued follow-up is needed to evaluate long-term survival.