26例子宫脉管内平滑肌瘤的临床、病理及超声表现特征分析

Clinical,pathological and ultrasonic features of intravascular leiomyoma of uterus:26 cases

目的探讨子宫脉管内平滑肌瘤(IVL)的临床、病理及其超声表现特征,并分析漏误诊原因。方法收集26例IVL患者的术前临床、超声图像资料及手术病理结果,分析相关临床、病理表现,总结超声特征。结果本组26例临床表现为月经异常14例,腹部包块10例,腹痛7例,尿频4例,痛经2例,心悸1例;超声发现18例瘤体局限在子宫宫体内,另外8例瘤体蜿蜒穿出子宫浆膜层蔓延至宫旁,10例(局限宫内瘤体4例,宫外瘤体6例)瘤体内部回声均可见多发裂隙状无回声,并且CDFI呈条索状或短棒状丰富血流信号;病理显示21例呈不规则烂肉状,质软,界限不清并伴有水肿及囊性变,其余5例呈结节状,质韧,界清。结论IVL患者临床表现及超声声像图缺乏特异性表现,局限于宫内者与普通型子宫平滑肌瘤较难鉴别,但是部分IVL瘤体(特别是蔓延至宫外的瘤体)在形态、内部回声以及血流信号等声像图表现出一定的特点,是术前正确诊断IVL的重要线索。

Objective To investigate the clinical,pathological and ultrasonic features of intravascular leiomyoma of uterus and analyze the causes for misdiagnosis.Method Preoperative clinical and ultrasound image data and surgical pathology findings of 26 IVL patients were collected to analyze the relevant clinical and pathological manifestations and summarize their ultrasound features.Results For clinical manifestations of 26 cases,there were 14 cases of abnormal menstruation,10 cases of abdominal mass,7 cases of abdominal pain,4 cases of urinary frequency,2 cases of dysmenorrhea and 1 case of palpitation.Ultrasound showed that 18 cases had the IVL tumors confined in the uterine while the other 8 cases had IVL tumors snaking through the serous coat of uterus to the uterine parametrial.Among them,10 cases(4 cases of intrauterine tumors and 6 cases of extrauterine tumors)showed multiple lacunar anechoic lesions,with CDFI showing cord or short-rod-like rich blood flow signals.Pathological findings showed irregular rotten meat with soft texture and unclear boundary,edema and cystic change in 21 cases and nodules with tough texture and clear boundary in 5 cases.Conclusion The clinical manifestations and ultrasound images of IVL patients lack specificity,and it is difficult to distinguish those confined to the uterus from the common uterine leiomyoma.However,some IVL tumors(especially those that spread outside the uterus)have certain characteristics in morphology,internal echo and blood flow signals,which are important clues for the correct diagnosis of IVL before operation.