低级别子宫内膜间质肉瘤的诊治进展

低级别子宫内膜间质肉瘤(LG-ESS)是一种惰性、激素敏感性恶性肿瘤，来自于子宫内膜结缔组织。LG-ESS缺乏特异性临床表现，术前误诊率较高。手术是主要治疗方式，术后Ⅱ～Ⅳ期患者需行规范化的抗雌激素治疗，放疗及化疗在本病中作用有限。目前LG-ESS缺少有效的全身治疗，分子遗传学研究发现，多数LG-ESS携带融合基因改变。本篇综述将从LG-ESS的分子遗传学、组织病理学等角度出发，综合阐述LG-ESS的诊治现状，并提出可能作用的靶点用于LG-ESS全身治疗。     

子宫内膜间质肉瘤的研究进展

子宫内膜间质肉瘤是一种来源于间叶组织的子宫肉瘤,其肿瘤细胞形似正常增殖期子宫内膜间质细胞,分为低度恶性子宫内膜间质肉瘤、高度恶性子宫内膜间质肉瘤以及子宫外内膜间质肉瘤.子宫内膜间质肉瘤早期即可能发生浸润和转移,因此早期发现、早期诊断和早期治疗对于本病具有重要的意义.但由于子宫内膜间质肉瘤组织细胞具有多分化潜能,镜下表现...     

子宫肉瘤研究进展

子宫肉瘤是发生于女性生殖器官的恶性肿瘤,其发病率低、预后差,主要有异常阴道出血、腹痛、腹部包块等临床表现。血清乳酸脱氢酶、血清中性粒细胞与淋巴细胞比值(NLR)等血清学指标及超声和磁共振成像等影像学检查可协助子宫肉瘤的术前诊断,但目前其诊断仍主要依靠术后病理结果。子宫肉瘤主要有子宫平滑肌肉瘤、子宫内膜间质肉瘤及子宫腺肉瘤3种病理类型。全子宫及双附件切除是标准手术方式,术后可根据不同病理类型及手术分期选择辅助治疗方式。通过查阅国内外文献,综述子宫肉瘤的临床表现、辅助检查、病理特征、治疗及预后等。     

子宫肉瘤研究进展

子宫肉瘤是发生于女性生殖器官的恶性肿瘤，其发病率低、预后差，主要有异常阴道出血、腹痛、腹部包块等临床表现。血清乳酸脱氢酶、血清中性粒细胞与淋巴细胞比值（NLR）等血清学指标及超声和磁共振成像等影像学检查可协助子宫肉瘤的术前诊断，但目前其诊断仍主要依靠术后病理结果。子宫肉瘤主要有子宫平滑肌肉瘤、子宫内膜间质肉瘤及子宫腺肉瘤3种病理类型。全子宫及双附件切除是标准手术方式，术后可根据不同病理类型及手术分期选择辅助治疗方式。通过查阅国内外文献，综述子宫肉瘤的临床表现、辅助检查、病理特征、治疗及预后等。     

子宫肉瘤诊治及预后的相关因素

子宫肉瘤是一类临床少见的恶性肿瘤,由于缺乏特异性临床表现,因此术前诊断率极低。子宫肉瘤病理分类较复杂,主要包括平滑肌肉瘤、癌肉瘤、子宫内膜间质肉瘤与未分类肉瘤等。近年来,关于子宫肉瘤病理学特征、临床病理分期、治疗与预后因素等方面的研究均取得了很大进展。     

子宫肉瘤诊治及预后的相关因素

子宫肉瘤是一类临床少见的恶性肿瘤,由于缺乏特异性临床表现,因此术前诊断率极低。子宫肉瘤病理分类较复杂,主要包括平滑肌肉瘤、癌肉瘤、子宫内膜间质肉瘤与未分类肉瘤等。近年来,关于子宫肉瘤病理学特征、临床病理分期、治疗与预后因素等方面的研究均取得了很大进展。     

子宫肉瘤的处理

主要讨论内容：子宫肉瘤的手术方式；子宫肉瘤化疗；子宫肉瘤放疗；子宫肉瘤激素治疗；子宫肉瘤是女性生殖系统少见的恶性肿瘤，约占妇科恶性肿瘤的1％～3％，其病理类型多样，常见的有子宫平滑肌肉瘤(LMS)、子宫内膜间质肉瘤(ESS)和子宫恶性中胚叶混合瘤(MMMT)。由于子宫肉瘤病因不明，早期诊断困难，所以治疗效果也不理想，5年生存率仅约30％。现结合病例对子宫肉瘤的治疗进行讨论。     

子宫肉瘤16例临床分析

子宫肉溜比较少见,我院1973年1月至1985年3月共收治16例,现将临床及病理资料分析如下。临床资料一、发病率:国内报道子宫肉瘤的发病率占子宫体恶性肿瘤的2.0%,我院子宫肉瘤占宫体恶性肿瘤的第二位。16例中子宫内膜间质肉瘤2例,子宫内膜间质异位症1例,平滑肌肉瘤13例,其中原发肉瘤3例,继发于子宫肌瘤的10例,继发性肉瘤占同时期经手术治疗的789例子宫肌瘤的2.3%,较一般报道为高。     

复发性子宫肉瘤的诊治

子宫肉瘤是罕见的女性生殖道恶性肿瘤,从组织学类型可分为子宫平滑肌肉瘤、子宫内膜间质肉瘤和恶性混合性中胚叶瘤。复发率高,治疗以手术、化疗等综合治疗为主,放疗效果不确切,可以协助控制局部复发,抗雌激素治疗也有一定效果。影响预后的因素很多,主要是临床期别和肿瘤大小。     

《FIGO 2018癌症报告》——子宫肉瘤诊治指南解读

正子宫肉瘤约占所有女性生殖道恶性肿瘤的1%,子宫体恶性肿瘤的3%～7%。因其罕见和组织病理学的多样性,目前仍缺乏最佳治疗方案和与不良预后相关的危险因素的共识。子宫肉瘤的亚型有平滑肌肉瘤、子宫内膜间质肉瘤(ESS)和子宫腺肉瘤。目前,癌肉瘤被认为     

经脐单孔腹腔镜手术治疗意外发现的低级别子宫内膜间质肉瘤一例体会

回顾总结1例经2次经脐单孔腹腔镜手术（transumbilical laparoendoscople single-site surgery，TU-LESS）治疗意外发现低级别子宫内膜间质肉瘤（low-grade endometrial stromal sarcoma，LG-ESS）的病例资料。患者初次手术术前诊断子宫肌瘤，通过行TU-LESS将子宫肌瘤剥除装袋冷刀旋切取出，术后病理确诊为LG-ESS，30 d后再次行TU-LESS全面分期手术见腹膜少许种植，术后给予孕激素治疗，随访20个月查肿瘤标志物正常，脐部切口及阴道断端愈合好。TU-LESS具有疼痛轻、伤口美观、术后恢复快等特点，最重要的是可安全有效取出肌瘤标本，避免了使用电动旋切器造成的肉瘤全腹广泛播散。但术中仍需警惕肌瘤剥除过程中肿瘤组织飞溅发生的腹膜种植，各操作环节均应注意严格遵循无瘤原则。     

Endometrial stromal sarcoma of uterus

Endometrial stromal sarcomas are the second most common uterine sarcomas. Currently, they are classified into low-grade endometrial stromal sarcomas and undifferentiated endometrial sarcoma. Low-grade endometrial stromal sarcomas are biologically low-grade uterine sarcomas, and typically composed of uniform cells intimately associated with prominent arterioles, resembling the endometrial stroma in proliferative phase. There is usually little cytological atypia or pleomorphism, and mitoses are scanty. In contrast, undifferentiated endometrial sarcomas are frankly malignant, lack specific differentiation and any features of normal endometrial stroma. It is a highly aggressive neoplasm, often exhibiting myometrial invasion, haemorrhage and necrosis, as well as marked nuclear pleomorphism and high mitotic activity. The diagnosis of undifferentiated endometrial sarcoma is reached after excluding other uterine tumours with a sarcomatous component, such as adenosarcoma and malignant mixed Müllerian tumour. Histological variants of endometrial stromal sarcomas, including the so called 'high-grade endometrial stroma sarcomas' are addressed. The problems with histologic diagnosis and application of immunohistochemical studies and molecular pathology are highlighted.     

术前如何鉴别诊断子宫肉瘤与子宫肌瘤

子宫肉瘤是一种少见的子宫恶性肿瘤,恶性程度高,术后复发率高,预后差。由于子宫肉瘤缺乏典型的临床表现、可靠的影像学特征和特异性的肿瘤标志物,准确的术前诊断非常困难。综合考虑多种因素,包括高危因素和临床症状、盆腔超声和MRI以及组织活检病理等,有助于术前鉴别子宫肉瘤与子宫肌瘤。     

子宫内膜间质肉瘤28例临床分析

目的:研究子宫内膜间质肉瘤的诊断、治疗和预后。方法:回顾分析28例子宫内膜间质肉瘤的临床资料。结果:确诊主要依靠病理检查。术前确诊率为67.9%,术中冰冻病理切片可将确诊率提高至89.3%。采取以手术为主的综合治疗,Ⅰ~Ⅱ期5年生存率为82.4%,Ⅲ~Ⅳ期5年生存率为0%;低度恶性子宫内膜间质肉瘤的3年和5年生存率分别为100%和92.9%,未分化子宫内膜肉瘤的3年生存率为22.2%。结论:术中冰冻切片至关重要,可明显提高确诊率;治疗以手术为主,综合放化疗。预后与临床分期、分化程度、治疗方法密切相关。     

Clinical presentation and diagnosis of uterine sarcoma, including imaging

Uterine sarcomas are uncommon tumours from mesenchymal elements. They are thought to arise primarily from endometrial stroma and uterine muscle, respectively. When endometrial stroma undergoes malignant transformation, it might be accompanied by a malignant epithelial component. Thus, malignant mesenchymal uterine tumours comprise leiomyosarcoma, endometrial stromal sarcoma, undifferentiated uterine sarcoma and carcinosarcoma. In this chapter, we discusses preoperative presentation, diagnosis and current progress in different imaging modalities, including ultrasonography, computed tomography, magnetic resonance image and positron emission tomography scan. We summarise advances in new technology, which might improve preoperative detection and enhance referral to gynaecologic oncologists for optimal staging surgery and treatment.     

子宫肉瘤生物治疗的研究进展

子宫肉瘤是一组少见的女性生殖系统恶性肿瘤,有广泛的组织学类型,3种主要亚型分别是子宫平滑肌肉瘤、子宫内膜间质肉瘤和恶性苗勒管混合瘤。治疗方法近年主张参照1988年国际妇产科联盟（FIGO）的子宫内膜癌手术病理分期标准和美国国立综合癌症网（The National Comprehensive Cancer Network,NCCN）规范进行,包括手术治疗、放疗、化疗和激素治疗等,预后欠佳。近年国际上致力于研究新的综合治疗方案改善患者预后,热点集中在生物治疗。对生物治疗的研究进展综述。     

The high-grade endometrial sarcoma: a rare entity

Introduction: With an estimated incidence of one to two per one million women, the endometrial stromal sarcoma (ESS) is a rare disease. It is subclassified into a high-grade and a prognostically better low-grade type. Evidence-based data for a standardized therapy is lacking. Case report: A 32-year-old obese nulligravida presented with persistent vaginal bleeding after the operation of an acute adnextorsion at another hospital. The repeat gynecological ultrasound examination showed a 5.3×5.3×3.6 cm vascularized, partially inhomogeneous mass in the uterus. A fractioned curettage yielded a differential diagnosis of malignant muellerian mixed tumor or a non-differentiated endometrial sarcoma. For completion of the operative treatment, laparotomy with hysterectomy, adnexectomy, and pelvine lymphonodectomy were performed. The final histological report described a 7 cm non-differentiated endometrial sarcoma with infiltration of the left ovary and 25 tumor-free lymph nodes. Discussion: Standard therapy for resectable sarcoma is abdominal hysterectomy and bilateral adnexectomy. So far, there is little data from studies reporting radio- or chemotherapy treatment of small patient numbers in an adjuvant setting. Conclusion: The ESS is a very rare disease of the uterus. Due to missing clinical data, it remains a multidisciplinary therapeutic challenge requiring individual decisions. To receive more information on this rare disease, treatment should be performed according to international protocols.