子宫内膜中肾样腺癌累及宫颈管间质一例

Mesonephric-Like Adenocarcinoma of the Endometrium Involving Cervical Interstitium:A Case Report

子宫内膜中肾样腺癌是一种罕见的妇科恶性肿瘤,发病率低,侵袭性较强,容易复发和转移,该类疾病的患者通常就诊时已处于晚期,目前暂无明确的治疗方案,故预后较差。报道1例子宫内膜中肾样腺癌累及宫颈管间质患者的诊治过程及随访情况。患者因绝经后阴道流液2次,不规则阴道出血20余天就诊。于2022年11月18日行宫腔镜检查术(初次手术),术后病理检查结果提示子宫内膜样腺癌,遂于2022年12月1日行经腹筋膜外全子宫切除术+双侧卵巢动静脉高位结扎术+双侧输卵管卵巢切除术+腹主动脉旁淋巴结切除术+盆腔淋巴结清扫术(二次手术)。结合两次手术病理检查结果,诊断子宫内膜中肾样腺癌Ⅱ期。术后给予5个周期紫杉醇联合卡铂化疗,1个疗程盆腔外照射放疗和1次阴道残端后装近距离放疗。随访至2024年4月10日,未见疾病复发转移。

Mesonephric-like adenocarcinoma of the endometrium is a rare gynecological malignancy.Due to the low incidence,strong invasiveness,easy recurrence and metastasis,patients with this kind of disease are usually seen at an advanced stage.There is no clear treatment plan at present,and the prognosis is poor.We report the diagnosis and treatment process of a patient with mesonephric-like adenocarcinoma of the endometrium involving cervical interstitium.The patient was treated for two times of postmenopausal vaginal fluid and irregular vaginal bleeding for more than 20 days.Hysteroscopy(primary surgery)was performed on November 18,2022,and the postoperative pathological examination results showed endometrioid adenocarcinoma.Therefore,transabdominal extrascial hysterectomy,bilateral ovarian arteriovenous high ligation,bilateral salpingo-oophorectomy,abdominal para-aortic lymphadenectomy and pelvic lymph node dissection(secondary surgery)was performed on December 1,2022.Combined with the results of pathological examination of the two surgeries,stageⅡof mesonephric-like adenocarcinoma of the endometrium was diagnosed.After surgery,the patient was given five cycles of paclitaxel combined with carboplatin chemotherapy,one course of pelvic external beam radiotherapy and one vaginal brachytherapy.No disease recurrence or metastasis was observed during follow-up until April 10,2024.