原发于宫角的子宫内膜癌临床误诊原因探讨

Exploration of Cause of Clinical Misdiagnosis of Endometrial Carcinoma Originating From Uterine Horn

目的探讨原发于宫角的子宫内膜癌误诊为子宫肌瘤变性的原因及防范误诊措施,以降低误诊率。方法回顾分析2022年3月收治原发于宫角的子宫内膜癌误诊子宫肌瘤变性1例临床资料。结果本例因绝经3年、左下腹痛半年就诊,彩超提示左宫角囊实性占位性病变(子宫肌瘤变性?),查癌抗原125和癌胚抗原正常。后行宫腔刮出物病理学检查考虑子宫内膜样腺癌,手术病理示左宫角子宫内膜样腺癌Ⅲ级伴部分梭形细胞分化,结合免疫组化结果诊断为子宫内膜样腺癌Ⅲ期。误诊时间6 d。给予手术治疗,术后予紫杉醇联合卡铂化疗2个疗程,患者一般状态尚可,未见复发或转移,尚在随访中。结论原发于宫角的子宫内膜癌临床症状及影像学表现不典型,早期容易误诊为子宫肌瘤变性等疾病。对于绝经期宫角占位性病变者应考虑到多种疾病的可能,结合患者病史(包括现病史、既往史)、实验室检查、影像学检查及病理检查有助于降低误诊率。

Objective To investigate the causes of misdiagnosis of endometrial carcinoma(EC)originating from uterine horn as uterine myomatosis and the preventive measures to reduce the misdiagnosis rate.Methods The clinical data of one patient with EC originating from uterine horn misdiagnosed as uterine myomatosis in March 2022 were retrospectively an-alyzed.Results The patient presented with menopausal for 3 years and lower left abdominal pain for 6 months,Color ultra-sound indicated cystic space occupying lesions(myomatosis?)in the left uterine horn.Cancer antigen 125 and carcinoembry-onic antigen normal.Endometrioid adenocarcinoma was considered by pathological examination of uterine curettage.Postoper-ative pathology showed that endometrioid adenocarcinoma in the left uterine corner was gradeⅢwith partial spindle cell differ-entiation,and combined with immunohistochemical results,stageⅢendometrioid adenocarcinoma was diagnosed.Misdiagno-sis lasted 6 d,and the patient underwent surgery.After surgical resection,the patient was treated with Paclitaxel combined with Carboplatin chemotherapy for 2 courses.The patient's general condition was good,no recurrence or metastasis was ob-served,and the follow-up was still under way.Conclusion The clinical symptoms and imaging findings of EC originating from the uterine horn are not typical,and it is more likely to be misdiagnosed as uterine myomatosis in the early stage.The possibility of multiple diseases should be considered for menopausal patients with space occupying lesions in the uterine horn,and combining the patient's medical history(including present history,past history),laboratory examination,imaging exami-nation and pathological examination can help reduce the misdiagnosis rate.