子宫及子宫外多发性脂肪平滑肌瘤一例

Multiple Lipoleiomyoma of Uterine and Extrauterine:A Case Report

脂肪平滑肌瘤较为罕见,同时存在多处子宫及子宫外脂肪平滑肌瘤更是极为罕见。报告1例患者因超声检查考虑右侧卵巢畸胎瘤可能入院行腹腔镜探查,术中发现子宫右后壁肌壁间外突结节、阑尾末端实性肿物及膀胱后壁脏层腹膜实性肿物,术后组织学病理及免疫组织化学均提示符合脂肪平滑肌瘤。脂肪平滑肌瘤是一种罕见的良性肿瘤,多见于子宫,子宫外脂肪平滑肌瘤的发生可能归因于妇科手术后的种植。子宫及子宫外的脂肪平滑肌瘤临床症状不典型,因其影像学显示有类似脂肪组织特征,尤其是肿物邻近附件区时,更易误诊为卵巢畸胎瘤,需引起重视,必要时进行磁共振成像检查以提高检出率。子宫及子宫外脂肪平滑肌瘤的治疗以手术切除为主,预后较好,但有恶性转化或与其他妇科恶性肿瘤共存的风险,术后需长期随访。

Lipoleiomyoma is relatively rare,and even rarer to appear in the uterus and extrauterine at the same time.We report a case of multiple lipoleiomyoma of uterine and extrauterine.The patient was suggested the possibility of a teratoma of the right ovary,and recommended laparoscopic exploratoration.A right posterior uterine wall inter teratoma muscular exophytic nodule,a solid mass at the end of the appendix and a solid peritoneal mass in the posterior wall of the bladder were found during operation.Postoperative histological pathology and immunohistochemistry showed the lipoleiomyoma.Lipoleiomyoma is a rare benign tumor,mostly in the uterus.The occurrence of extrauterine lipoleiomyoma may be attributed to implantation after gynecological surgery.Clinical symptoms of uterine and extrauterine lipoleiomyoma are atypical.As the fat within the mass can be detected on imaging examination,especially when the mass is adjacent to the adnexal,it is more likely to be misdiagnosed as ovarian teratoma.MRI should be performed if necessary,to improve the detection rate.The treatment of uterine and extrauterine lipoleiomyoma is mainly surgical resection,with a good prognosis.There is a risk of malignant transformation or coexistence with other gynecological malignancies,so the long-term postoperative follow-up is required.