妊娠合并复发性子宫内膜间质肉瘤1例

Pregnancy with recurrent endometrial stromal sarcoma:a case report

本文报道了1例妊娠合并复发性子宫内膜间质肉瘤的临床特点以及诊治经过。患者2017年行腹腔镜下手术剔除子宫肌瘤,术后病理诊断为低级别子宫内膜间质肉瘤,因患者强烈的生育需求,在知情选择的情况下密切随访,病情稳定未复发的状态下备孕并成功受孕。此次妊娠期间规律产前检查,孕37周^(+4)常规彩超检查时发现盆腔一大小6.3 cm×4.5 cm的稍低回声光团。盆腔MRI提示右侧附件区、前盆壁、左侧盆壁髂血管旁见多发实性结节,较大者约58 mm×28 mm;弥散加权成像示盆腔多发结节、肿块,可见明显扩散受限。诊断为盆腔内多发实性结节、肿块,考虑肉瘤复发可能性大。完善颅脑CT及肺部CT,均提示未见明显转移病灶,请妇科肿瘤放化疗科会诊,产前诊断考虑妊娠合并肿瘤复发可能性大,排除手术禁忌证后,孕38周+3全身麻醉下行子宫下段剖宫产术,娩出一活女婴。剖宫产术中快速冰冻病理证实切除包块为子宫内膜间质肉瘤复发,随即行筋膜外全子宫切除术+双侧卵巢及输卵管切除术+阑尾切除术+大网膜切除术+盆腔病损切除术(右侧)+盆腔粘连松解术。术后常规病理再次证实为复发性低级别子宫内膜间质肉瘤。术后恢复可,患者顺利出院。术后随访2年,未见远处转移复发病灶。

This paper reported the clinical characteristics,diagnosis,and treatment of a case of recurrent endometrial stromal sarcoma with term pregnancy.The patient had undergone laparoscopic surgery to remove hysteromyoma before conception in 2017,which was pathologically diagnosed as low-grade endometrial stromal sarcoma after surgery.Due to her strong reproductive willingness,the patient attempted to conceive in light of her stable condition and no evidence of recurrence and was closely followed up with an informed choice.She conceived successfully in 2020 and underwent regular pregnancy examinations.Ultrasound examination at 37^(+4) weeks of gestation revealed a slightly hypoechoic mass of about 6.3 cm×4.5 cm size in the pelvic cavity.After admission,a pelvic MRI indicated multiple solid nodules in the right adnexa uteri and beside the iliac vessels in the left pelvic wall and anterior pelvic wall with the larger one being about 58 mm×28 mm.Diffusion-weighted imaging showed multiple pelvic nodules and masses with significant diffusion restriction.The patient was diagnosed as having multiple solid nodules and masses in the pelvic cavity,and the recurrence of sarcoma was highly suspected.Brain CT and lung CT showed no obvious metastatic lesions.A consultation involving the Department of Gynecological Tumor Chemoradiotherapy was held and the sarcoma recurrence during pregnancy was prenatally diagnosed.After ruling out the contraindications for surgery,a cesarean section was performed in the lower segment of uterus under general anesthesia and a live female baby was delivered at 38+3 weeks.The excised mass was confirmed as recurrent uterine stromal sarcoma by rapid freezing pathology during cesarean section.A combination surgery was performed subsequently,including total extra-fascial hysterectomy,bilateral oophorectomy,bilateral salpingectomy,appendectomy,greater omentum resection,pelvic lesion resection(right side),and pelvic adhesiolysis.Recurrent low-grade uterine stromal sarcoma was reconfirmed by postoperative pathology.The patient was discharged after recovery.After two years of follow-up,no distant metastasis recurrences were found.