低级别子宫内膜间质肉瘤误诊3例分析

Analysis of misdiagnosis of low-grade endometrial stromal sarcoma in 3 cases

目的探讨低级别子宫内膜间质肉瘤(LG-ESS)误诊原因,提高该疾病诊断的准确率。方法回顾性分析3例被误诊的LG-ESS患者的临床资料。结果3例患者年龄36~45岁,2例表现为月经量增多,1例表现为腹痛。2例术前误诊为子宫肌瘤,行经腹子宫肌瘤剥除术。1例术前误诊为脉管内平滑肌瘤病,行次广泛全子宫+双附件+大网膜切除术+肿瘤细胞减灭术。3例术后病理均诊断为LG-ESS。2例补充行全子宫+双附件切除术,1例未行补充手术。术后均予以孕激素治疗,目前均无复发。结论LG-ESS发病率低,误诊率高。临床医师应提高术前诊断的准确率,误诊发生后积极采取补救措施,从而改善患者预后。

Objective To investigate the misdiagnosis causes of low grade endometrial stromal sarcoma(LG-EsS)and improve the accuracy of diagnosis.Methods The clinical data of 3 misdiagnosed LG-ESS were retrospectively analyzed.Results Three patients were aged 36 to45 years,2 presented with increased menstrual volume,and 1 presented with abdominal pain.Two cases were misdiagnosed as hysteromyoma and underwent transabdominal hysteromyoma excision.One case was misdiagnosed as intravascular leiomyomatosis before surgery and underwent sub-extensive hysterectomy+bilateral adnexectomy+greater omentum resection+tumor cell reduction.All 3 cases were confirmed to be LG-Ess by postoperative pathology.Total hysterectomy and bilateral adnexectomy were performed in 2 patients,and no supplementary surgery was performed in 1 patient.All patients were treated with progesterone after surgery,and there was no recurrence at present.Conclusion LG-ESS has low incidence and high misdiagnosis rate.Clinicians should improve the accuracy of preoperative diagnosis and actively take remedial measures after misdiagnosis,so as to improve the prognosis of patients.