子宫平滑肌肿瘤病理诊断与临床特征分析

目的 分析研究子宫平滑肌肿瘤应用病理诊断鉴别的有效性。方法 选取子宫平滑肌肿瘤患者80例,入组患者,采取肿瘤病理诊断,在光学显微镜下针对于组织类型进一步分析。结果 肿瘤发病部位位于肌壁间中的肿瘤发生率更高(P<0.05),肿瘤病理组织学分型中,分为平滑肌瘤、平滑肌肉瘤、恶性潜能未定平滑肌肿瘤。平滑肌瘤更多,占比较大(P<0.05)。结论 针对于核裂象数目、细胞学特性以及凝固性肿瘤细胞坏死的研究分析可实现子宫平滑肌肿瘤鉴别诊断。     

子宫腺肌瘤的磁共振成像动态增强特征

目的探讨子宫腺肌瘤的磁共振成像(MRI)动态增强特征。方法选取23例经病理证实为子宫腺肌瘤的患者作为研究对象,均行常规MRI平扫、动态增强扫描,选取瘤灶及邻近的子宫内膜为感兴趣区域,计算各感兴趣区域在增强16、32、48、64、128 s时相强化速率(Sp),用配对样本t检验分析各时相瘤灶与其邻近的子宫内膜强化速率的差异;分析两者的时间-信号强度曲线(TIC)的特征。结果子宫腺肌瘤与子宫内膜的各时相Sp差异无统计学意义(P>0.05),同一患者的子宫腺肌瘤与邻近子宫内膜的TIC形态近似,且表现为早期急速上升至峰值,后为持续的平台期。结论 MRI动态增强有助于子宫腺肌瘤的诊断及鉴别诊断。     

子宫平滑肌瘤588例临床病例分析

子宫平滑肌瘤是女性生殖系统最常见的肿瘤，育龄妇女中发病率为20％～30％，其中绝大部分为良性的平滑肌瘤，平滑肌肉瘤少见，发病率〈1％,子宫平滑肌瘤的病因尚未十分明确，目前认为以雌激素水平过高有关，其治疗仍以手术治疗为主。本文对588例子宫平滑肌瘤临床表现及病理诊断结果进行分析。     

非典型腺细胞在宫颈细胞学检查中临床分析

目的探讨非典型腺细胞(AGC)在宫颈细胞学检查中的诊断意义。方法回顾性分析自2015年9月至2018年8月沈阳市妇婴医院病理科宫颈液基细胞学检查资料库中的85 391例样本的资料,其中,AGC患者212例,随诊有组织学病理81例。分析细胞学检查与组织病理学的诊断结果,以及组织学来源与患者年龄的关系。结果细胞学诊断AGC患者212例,非典型腺细胞-宫颈来源43例(20.28%),非典型腺细胞子宫-子宫内膜来源2例(0.94%),非典型腺细胞倾向瘤变22例(10.38%),非典型腺细胞-来源不明14例(6.60%)。组织学病理随诊81例,良性病变47例(58.02%),癌前病变18例(22.22%),恶性肿瘤16例(19.75%),其中,10例来源于宫颈、6例来源于子宫内膜。未发现子宫内膜非典型增生。根据年龄分组,年龄≥40岁患者的恶性病变来源有显著差异(P<0.05),在宫颈来源癌前病变中,其检出率随年龄增加而增加。结论细胞学AGC随诊中,病理组织学为恶性的多为宫颈腺上皮病变,少数为子宫内膜病变,年龄≥40岁患子宫内膜腺癌的风险增高。     

子宫腺肌病痛经机理的研究进展

子宫腺肌病是子宫内膜腺体及间质侵入子宫肌层的一种病变。多数学者从人类及动物模型研究中发现子宫壁受损、炎症所致薄弱，宫腔压力的升高使子宫内膜侵入肌层是组织学基础．而高雌激素水平．自身免疫反应，血管内皮因子等使异位内膜维持其活性。近年来，此病的发病率逐年上升，已严重危害了妇女身心健康。痛经是子宫腺肌病最主要症状之一。文献报道子宫腺肌病患者痛经率高达64．8％-77．80%。众多学者对痛经机制进行了广泛的研究，现综述如下，为寻找更有效的治疗药物拓展新的思路。     

子宫内膜间质肉瘤超声误诊分析

目的：探讨子宫内膜间质肉瘤的超声表现并对其超声误诊原因进行分析.材料和方法：对14例经手术及病理证实的子宫内膜间质肉瘤患者声像图进行回顾性分析.结果：根据超声所见病变分为3型.Ⅰ型：宫腔型（n=8）,Ⅱ型：宫壁型（n=3）,Ⅲ型：宫腔及宫壁型（n=3）.6例（42.9%）误诊为子宫良性病变[子宫肌瘤（肌壁间或黏膜下）、子宫腺肌症合并腺肌瘤或肌瘤];4例（4/14）误诊为子宫内膜癌,4例诊断为子宫恶性肿瘤.结论：子宫内膜间质肉瘤声像图缺乏特异性是误诊的主要原因,不同分型声像图应与相应疾病进行鉴别,并结合临床资料,可以提高对该病的诊断符合率.     

子宫肌瘤106例中医治疗体会

子宫肌瘤属中医“症瘕”范畴,是生殖器最多见的良性肿瘤,好发于30-50岁妇女。本人临床中根据患者年龄、肌瘤大小、部位、有无生育要求,有无合并症及子宫出血的严重程度而综合分析,确定治疗方法,对非手术类,全部中医分型辨证施治,取得满意效果,现总结如下。1资料与方法1.1一般资料106例中门诊病例66例,住院病例40例。30岁以下8例,30-40岁58例。41-50岁30例,50岁以上10例。106例均经妇检及B超确诊。子宫粘膜下肌瘤18例,肌壁间肌瘤59例,浆膜下肌瘤29例。其中子宫内膜病检:囊性增生3例,腺瘤样增生1例。肌瘤变性5例,合并卵巢囊肿12例,肌腺瘤10例…     

MMP-3、MMP-9、TIMP-1在子宫腺肌病中的表达及其意义

 目的 研究MMP-3、MMP-9、TIMP-1在子宫腺肌病中的表达,探讨子宫腺肌病的发病机制.方法 采用二步法免疫组化的方法检测子宫肌腺病45例在位内膜(A组)、36例异位内膜(B组)和28例对照组内膜中的MMP-3、MMP-9、TIMP-1含量.结果 MMP- 9在研究组A、研究组B中的表达强于对照组,差异有统计学意义(P<0.05);MMP-3在研究组A、研究组B中的表达强于对照组,差异有统计学意义(P<0.05);TIMP-1在对照组中的阳性表达弱于研究组A,差异有统计学意义(P<0.05),研究组A强于研究组B的阳性表达,差异有统计学意义(P<0.05).结论 子宫腺肌病的发病可能与MMP-3、MMP-9、TIMP-1的异常表达有关.     

贲门胃底部固有肌层起源肿物的超声内镜诊断与分型研究

目的 探讨贲门胃底部固有肌层起源肿物超声内镜诊断与分型的方法.方法 沈阳军区总医院内窥镜科2011年1月-2015年6月间经超声内镜诊断为贲门胃底部固有肌层起源肿物的患者102例,均经内镜或外科治疗获得确切病理结果,其中行内镜下微创剥离切除83例,外科手术切除19例.对所有病例的超声内镜及术后完整病理诊断资料进行回顾性分析.结果 102例患者中男39例,女63例,年龄56.2±12.0(25～85)岁.病变大小3.72±2.18(0.4～10.4)cm.术前超声内镜诊断平滑肌瘤81例,间质瘤21例.术后病理及免疫组化证实5例平滑肌瘤术前误诊为间质瘤,误诊率为4.9％(5/102).平滑肌瘤患者中孤立结节型29例,蚓型21例,多结节型36例.结论 超声内镜是贲门胃底部固有肌层起源肿物安全有效的诊断和分型方法.     

子宫内膜良、恶性息肉样病变的MR表现与临床病理对照分析

目的 探讨常规MR及动态增强扫描在子宫内膜息肉样病变中的诊断价值及病理基础.方法 回顾性分析经病理证实的子宫内膜息肉样病变48例,其中恶性肿瘤26例(23例I期子宫内膜癌和3例子宫内膜肉瘤),良性息肉样病变22例(子宫内膜息肉12例和子宫黏膜下肌瘤10例),分析其MR平扫及增强图像病灶特征,并与病理结果 进行对照.采用Fisher精确概率法对纤维核、囊变区及完整结合带在不同子宫内膜息肉样病变中的出现概率进行分析比较.结果 26例子宫内膜恶性息肉病变,其中23例子宫内膜癌在MR T2WI上均表现为子官内膜均匀等或稍高信号肿块(23/23),增强后相对于肌层均呈低信号(23/23),并伴结合带中断或模糊(20/23);子宫内膜含间质成分恶性肿瘤3例,2例为腺肉瘤,1例为癌肉瘤,MR T2WI均为混杂信号,早期局部明显强化,至后期仍明显持续强化;26例子宫内膜恶性息肉病变在MRI上子宫结合带中断或模糊征象出现的概率(23/26)均较子宫内膜息肉(1/11)及子宫黏膜下肌瘤(1/9)高,差异具有统计学意义(P值均<0.05).肿块内小囊变影及不定形纤维核影见于子宫内膜息肉(分别为8/12及5/12),2种征象在子宫内膜息肉中的出现概率均较子宫内膜恶性息肉样病变(3/26及2/26)及子宫黏膜下肌瘤(0及2/10)高,差异具有统计学意义(P值均<0.05);10例子宫黏膜下平滑肌瘤MRI均表现为境界清晰,T2WI呈等或稍低信号肿块,且出现子宫黏膜推移征象(10/10).MR平扫及增强扫描对所有48例子宫内膜息肉样病变的定性诊断敏感度为92.3%(24/26),特异度为83.3%(20/24),准确度为95.8%(46/48).结论 MRI平扫及增强扫描能反映子宫内膜良、恶性息肉样病变的特征,具有很高的诊断价值.     

子宫肌瘤数字化三维动脉血管网的构建和意义

目的探讨构建基于CTA数据的子宫肌瘤数字化三维动脉血管网的方法 ,并通过其观察肌瘤的血供来源和血供分布类型。方法选取子宫肌瘤患者64例行双源CTA扫描,获取CT原始图像后利用Mimics10.01软件对子宫肌瘤动脉血管网进行数字化三维重建,并作分析。结果 (1)构建了64例患者的子宫肌瘤数字化三维动脉血管网,可清晰的显示盆腔大动脉、子宫动脉及肌瘤的主要供血血管和血供分布情况。(2)患者肌瘤的血供来源分别为子宫动脉(81.25%)、子宫动脉和单侧卵巢动脉(10.9%)、子宫动脉和双侧卵巢动脉(4.69%)及卵巢动脉(3.1%)。(3)子宫肌瘤血供的分布类型可分为4型:①Ⅰ型:一侧动脉供血为主型(一侧子宫动脉伴/不伴同侧卵巢动脉的供血量显著超过子宫肌瘤瘤体的1/2),占35.9%(23/64);②Ⅱ型:双侧动脉供血均衡型(双侧子宫动脉伴/不伴同侧卵巢动脉的供血量分别约为子宫肌瘤瘤体的1/2),占53.1%(34/64);③Ⅲ型:单纯一侧子宫动脉供血型,占7.8%(5/64);④Ⅳ型:卵巢动脉供血型,占3.1%(2/64)。结论利用CTA和重建软件可以构建出数字化三维的子宫肌瘤动脉血管网,并可进行血供来源及分布的分析,为手术方案的制定和临床教学提供参考。     

Value of dynamic enhanced magnetic resonance imaging for distinguishing between ovarian fibroma and subserous uterine leiomyoma

PURPOSE: The purpose of this study was to assess the accuracy of magnetic resonance imaging (MRI), particularly, dynamic MRI, in distinguishing ovarian fibromas from subserous uterine leiomyomas. MATERIAL AND METHODS: Fifteen ovarian fibromas and 15 subserous uterine leiomyomas were retrospectively reviewed. All MR examinations included dynamic contrast-enhanced (DCE) sequences. Morphological criteria (size, T1 and T2 signals, ovarian tissue, associated uterine leiomyoma, and pelvic fluid), arterial vessels, time-intensity curves (maximal enhancement and signal intensity at 30, 60, and 90 seconds), and signal intensity on delayed T1-weighted images were compared between the 2 groups. RESULTS: No significant difference in morphological criteria was noted between the 2 types of masses. Visualization of arterial vessels was more frequent in uterine leiomyomas than in ovarian fibromas (P= 0.002). The DCE MR enhancement rate was higher for uterine leiomyomas than for ovarian fibromas in terms of both maximal enhancement (P < 0.001) and enhancement rate at 30 (P = 0.009), 60 (P = 0.007), and 90 seconds (P = 0.0009). On delayed T1 postcontrast sequence, no statistical difference exists between signal intensity of ovarian fibromas and uterine leiomyomas. CONCLUSION: Our findings suggest that DCE MRI can distinguish ovarian fibromas from uterine leiomyomas and should be used if sonography fails to show the origin of a pelvic mass.     

恶性潜能未定子宫平滑肌瘤临床表现及诊治方法分析

 目的 探讨梭形细胞分化的恶性潜能未定子宫平滑肌肿瘤(uterine smooth muscle tumor of uncertain malignant potential,STUMP)的临床表现、辅助检查及诊断方法。方法 选取2009-01至2015-12在医院妇科接受手术治疗的梭形细胞分化的STUMP患者,病理科医师采用同一诊断标准对病理切片再次复核。通过搜集临床资料进行回顾性研究。结果 共23例,均为育龄期或围绝经期女性,年龄41~50岁的占60.9%;均表现出与子宫肌瘤或肉瘤相似的临床症状,但以月经量增多,经期延长者最多见(56.5%);22例术前超声将该肿瘤诊断为良性平滑肌瘤,1例被诊断为卵巢肿物;术中见肿瘤多生长于宫体肌壁间(60.9%);最大径线2～16 cm,平均6.4 cm;剖面与良性子宫肌瘤类似。结论 STUMP患者的年龄分布、临床表现、超声声像图等均与良性子宫平滑肌瘤更为相似,术前难以区分,确诊仍需依靠病理学检查。     

Leiomyoma recurrence after uterine artery embolization

PURPOSE: The purpose of this study was to evaluate the rate of leiomyoma recurrence after uterine artery embolization (UAE) for symptomatic uterine leiomyomas. MATERIALS AND METHODS: A prospective study of UAE of uterine leiomyomas has been ongoing at the authors' hospital since 1997. The recurrence rate was assessed in June 2002. Vascular access was obtained via the right common femoral artery and free-flow embolization was performed with use of 150-250- micro m polyvinyl alcohol particles and an absorbable particle sponge. Follow-up included clinical and ultrasound (US) examinations at 3, 6, and 12 months, and once per year thereafter. RESULTS: Eighty-five UAE procedures were performed between January 1997 and June 2000. Five patients were lost to follow-up. Median follow-up was 30 months (range, 2-57 months). There were six immediate failures: one technical failure, three cases of concomitant disease (one case of endometrial cancer and two cases of adenomyosis), and two cases of large subserosal leiomyomas. There were eight late failures or recurrences: one case of leiomyoma progression, seven cases of new leiomyomas. Mean time to recurrence was 27.4 months. CONCLUSIONS: Although UAE is an effective primary treatment for leiomyomas, this study recorded a recurrence rate of 10% at just more than 2 years. Clinical and US examinations are needed before UAE to exclude pedunculated submucosal leiomyomas and cancers, and must be repeated for more than 2 years after UAE to monitor patients' progress. Longer follow-up and more events are needed to define risk factors for recurrence.     

Characteristics of vascular supply to uterine leiomyoma: an analysis of digital subtraction angiography imaging in 518 cases

Objectives

To investigate the characteristics of the vascular supply to uterine leiomyomas based on digital subtraction angiography.

Methods

The feeding artery, vascularity of uterine leiomyoma and visualisation of the ovarian vessel network were studied in 518 patients undergoing uterine artery embolisation (UAE). Mean patient age was 38.97?±?6.09 years (range, 22–54 years). The types of vascular supply were analysed by the vascular supply to the leimyoma and grades of vascularity by the degree of enhancement of the leimyoma compared with the myometrium.

Results

The blood supply of leiomyomas could not be classified in 3.28 % of patients. Blood was supplied solely by the uterine artery in 88.61 % of leiomyomas, 8.11 % of leiomyomas were partially fed by an ovarian artery, and 0.39 % by it exclusively. Leiomyoma blood supply was classified as unilateral predominant, bilateral balanced, single unilateral uterine artery and single ovarian artery in 36.48, 49.23, 10.62 and 0.39 % of cases respectively. Leiomyoma vascularity was classified as extremely hypervascular (8.69 %), hypervascular (46.14 %), isovascular (33.39 %) and hypovascular (11.78 %).

Conclusions

Uterine leiomyomas supplied by both uterine arteries and with rich blood flow were seen in approximately 50 % of patients. However, close attention also should be given to the collateral circulation during UAE.

Key Points

? The vascularity of uterine leiomyomata was studied by digital subtraction angiography. ? Most uterine leiomyomtas have a bilateral uterine artery blood supply. ? Attention should be given to collateral circulation during embolisation procedures.     

Uterine artery embolization in the primary treatment of uterine leiomyomas: technical features and prospective follow-up with clinical and sonographic examinations in 58 patients

OBJECTIVE: The purpose of this study was to analyze the technical features of uterine artery embolization and to evaluate the effectiveness of this method as the primary treatment of uterine leiomyomas in a series of 58 patients monitored by clinical and sonographic examinations. SUBJECTS AND METHODS: Fifty-eight women (age range, 33-65 years; mean age, 44.5 years) with symptoms caused by uterine leiomyomas (abnormal bleeding, bulk-related symptoms, pelvic pain) were included in this prospective study. We performed embolization with a single catheter using the single-femoral artery approach, injection of particles (150-250 mm), and an absorbable gelatin sponge. Postprocedural pain was assessed using a visual analog scale. Systematic follow-up included clinical and sonographic examinations at 3 months for 58 patients, at 6 months for 46 patients, at 1 year for 27 patients, and at 2 years for seven patients. RESULTS: Embolization was performed without problems in 84% of the patients. Post-procedural pain control was excellent in 90% of the patients. In most patients, symptoms were improved or had resolved at 3 months (90%), 6 months (92%), and 1 year (93%), and all patients were symptom-free at 2 years. Clinical failure of treatment occurred in only two patients (3%). Progressive reduction in leiomyoma size was revealed during sonographic follow-up, and new leiomyomas were seen in one patient at 2 years. CONCLUSION: Uterine artery embolization is an endovascular method for the treatment of uterine leiomyomas that is clinically effective in most patients and that induces a progressive reduction in the size of the largest leiomyomas.     

子宫平滑肌瘤的MRI诊断

目的探讨子宫平滑肌瘤的MRI表现及其诊断价值。方法对30例子宫平滑肌瘤患者行MRI检查,SE序列,横断面T     

Outcomes after uterine artery embolization for pedunculated subserosal leiomyomas

PURPOSE: To assess the safety and efficacy of uterine artery embolization (UAE) treatment of pedunculated subserosal leiomyomas. MATERIALS AND METHODS: A review of patients undergoing UAE in a 30-month period (July 2004 to December 2006) was performed. Cases in which a pedunculated subserosal tumor (volume>or=4 cm3) was embolized were analyzed. The preprocedural volumes of the pedunculated tumor and uterus and the diameter and vascularity of the tumor and stalk were recorded. Posttreatment sizes of the pedunculated leiomyoma, stalk, and uterus were recorded, as was the presence or absence of complication(s). RESULTS: A total of 240 patients underwent embolization. Pedunculated subserosal leiomyomas were treated in 16 women, with a technical success rate of 100%. Preprocedural mean tumor and uterine volumes were 372 cm3 and 789 cm3, respectively. The mean stalk diameter was 2.7 cm (range, 0.8-7.8 cm). All pedunculated leiomyomas exhibited enhancement on contrast agent-enhanced magnetic resonance (MR) imaging (n=13) or vascularity on Doppler ultrasonography (US; n=3). Stalk vascularity was noted on MR imaging in 13 patients and was not assessed in the remaining three, who underwent US imaging. Imaging follow-up (mean, 5.9 months after UAE) demonstrated mean tumor volume reduction of 39.3% (95% confidence interval [CI], 28.2%-50.5%) and mean uterine volume reduction of 37.6% (95% CI, 26%-49.3%). There were no cases of continued tumor perfusion and no major complications. There was one minor complication of prolonged hospital stay (36 hours) for pain control. CONCLUSION: UAE was successfully and safely performed for pedunculated subserosal leiomyomas, with a tumor volume reduction of 39% and no unique complications related to these lesions.     

子宫肌瘤动脉栓塞治疗:对卵巢功能的影响及血清性激素的变化

目的:探讨子宫动脉栓塞术(UAE)治疗子宫肌瘤对月经和卵巢功能的影响。方法:66例子宫肌瘤行UAE后随访3～33个月,观察月经变化,其中15例在preUAE和postUAE3个月,监测血清黄体生成素(LH)、卵泡刺激素(TSH)、泌乳素(PRL)、孕酮(Prog)、雌二醇(E2)等5种性激素变化。结果:47例(81%)UAE后恢复正常月经或明显改善,5例(8.6%)有一过性月经紊乱,3例(5.2%)出现闭经(年龄>45岁)。14例血清5种性激素在preUAE和postUAE变化差异无显著性意义(P>0.05),1例(年龄46岁)5种性激素preUAE处于卵泡期水平,postUAE3月处于绝经期。结论:UAE治疗子宫肌瘤后,大部分患者可恢复正常月经,对卵巢功能影响小,对血清性激素水平无明显影响,但极少数年龄大于45岁者postUAE可出现闭经。     

动态MRI对卵巢纤维瘤与浆膜下子宫肌瘤的鉴别诊断价值

目的　探讨MR早期动态增强对MR平扫表现为T2 WI等或低信号的卵巢纤维瘤与浆膜下子宫肌瘤鉴别诊断的价值。方法　分析经手术病理证实的 4 5例卵巢纤维瘤及浆膜下子宫肌瘤MR平扫及早期动态增强表现 ,其中卵巢纤维瘤 10例 ,浆膜下子宫肌瘤 35例。结果　卵巢纤维瘤2例T2 WI呈等信号 ,8例呈低信号 ,T1WI皆为低信号 ,增强早期多为弱强化 ,延迟期消退缓慢 ,早期强化率值 (SI10 0 )低 ,曲线达到高峰所需时间 (TTP2 0 0 )长 ;浆膜下子宫肌瘤 7例T2 WI呈等信号 ,2 8例呈低信号 ,T1WI皆为低信号 ,增强扫描早期多为中 高度强化 ,早期强化率值SI10 0 高 ,曲线达到高峰所需时间TTP2 0 0 短 ;两组强化曲线形态不同 ,差异有显著性意义 (P <0 0 0 1)。结论　MR平扫表现相似的卵巢纤维瘤和浆膜下子宫肌瘤 ,早期动态增强扫描强化曲线形态不同 ,有助于两者的鉴别。