子宫静脉内平滑肌瘤病2例及文献复习

目的:探讨子宫静脉内平滑肌瘤病(IVL)的临床表现和诊治要点。方法:对2例确诊IVL患者的临床资料进行回顾分析,并对相关文献进行复习。结果:2例IVL患者临床表现与子宫肌瘤的临床表现相同,术前无特异性诊断方法,病理检查是诊断该病的依据。结论:IVL无特异性临床表现,术前不易诊断,应注重术中探查及病理检查。     

子宫静脉内平滑肌瘤病3例报告并文献复习

目的：探讨子宫静脉内平滑肌瘤病（IVL）的临床特征和处理方法,提高对该病的认识。方法对已确诊的3例子宫静脉内平滑肌瘤病患者的临床资料进行回顾分析,并复习相关文献。结果子宫IVL患者与子宫肌瘤的临床表现相同,表现为经量增多、经期延长、盆腹腔包块。术前无特异性的诊断方法,术中发现肌壁间静脉内可见蜂窝状、蠕虫状结节,延伸至宫壁。宫旁静脉增粗,静脉内可见索条状组织,质韧如橡皮样。病理检查是确诊的依据。本病典型病理改变为静脉内见蠕虫样、条索状瘤体,可抽出,镜下呈良性平滑肌瘤的形态,不侵袭静脉壁。结论子宫IVL是具有恶性生物学行为的良性疾病,术前诊断率极低,术中能否正确诊断、处理关系到患者预后,需注重术中探查,提高术中确诊率。     

子宫静脉内平滑肌瘤病2例报告

对2例少见的子宫静脉内平滑肌瘤病(IVL)病例进行报道并探讨临床特点和诊治方法。2例患者均一期手术成功切除肿瘤,1例术前明确诊断,另1例术中偶然发现右卵巢内蚯蚓样肿瘤。IVL易被临床忽视,应注重术前检查及术中探查,根治IVL依靠彻底性手术。本病易复发,建议术后长期随访。     

子宫静脉内平滑肌瘤病3例分析并文献复习

目的探究子宫静脉内平滑肌瘤病的诊断及治疗方法。方法回顾性分析解放军总医院2004年1月-2010年11月收治的3例子宫静脉内平滑肌瘤病患者的临床及病理资料,并对相关文献进行复习。结果 3例中1例月经量增多,经期延长,1例有子宫肌瘤剔除手术史,术后随访发现盆腔包块;1例无临床表现,体检发现。3例术前超声检查2例提示平滑肌瘤,1例不除外恶性可能,无一确诊,均行全子宫切除术,术后病理确诊为静脉内平滑肌瘤病。1例术后5d发现瘤体残留,另2例分别随访17和34个月未发现复发。结论子宫静脉内平滑肌瘤病是具有恶性肿瘤生物学特性的良性病变,术前诊断率低,确诊主要依靠病理检查,治疗首选手术切除,术后应长期密切随诊。     

子宫静脉内平滑肌瘤病三例报告

子宫静脉内平滑肌瘤病(intravennus leionlyomatosis IVL)是一种非常少见的子宫良性肿瘤,此肌瘤向子宫脉管内生长或由脉管本身的平滑肌组织增生后,向子宫外脉管腔扩展,除静脉外淋巴管也可受累,所以又称脉管内平滑肌瘤病。病理     

子宫静脉内平滑肌瘤病1例

1病例资料患者,马某,女,42岁,主因月经量增多6个月,发现盆腔包块8 d于2008年9月9日入院。患者平素月经规则,量中,无痛经。生育史:孕3产1,上环17年。半年前无诱因出现月经增多,约为原来的2倍,有血块,时有头晕乏力,但经期、周期同以往,无     

静脉内子宫平滑肌瘤病一例报告

目的 报道1例罕见的静脉内子宫平滑肌瘤病病例。方法　通过病史,体检、手术所见和病理检查结合文献,分析讨论。结果　病理诊断为子宫静脉内平滑肌瘤病伴壁间型平滑肌瘤。结论　本病是一种少见的具有侵袭性生物学行为的良性肿瘤。肿瘤可沿腔静脉生长直至右心房而产生相应症状。可复发并发生肺转移,但预后良好。病理上需与内膜间质肉瘤,平滑肌肉瘤和子宫肌瘤伴血管浸润行鉴别诊断。     

静脉内子宫平滑肌瘤病一例报告

目的 报道1例罕见的静脉内子宫平滑肌瘤病病例。方法　通过病史,体检、手术所见和病理检查结合文献,分析讨论。结果　病理诊断为子宫静脉内平滑肌瘤病伴壁间型平滑肌瘤。结论　本病是一种少见的具有侵袭性生物学行为的良性肿瘤。肿瘤可沿腔静脉生长直至右心房而产生相应症状。可复发并发生肺转移,但预后良好。病理上需与内膜间质肉瘤,平滑肌肉瘤和子宫肌瘤伴血管浸润行鉴别诊断。     

子宫静脉内平滑肌瘤病1例

病人,女,50岁。平素月经周期规律,近半年来自觉下腹部胀痛不适。妇科检查：盆腔偏左侧可扪及如孕8个月大小的肿物,质中。彩超检查：子宫稍增大,形态尚可,肌层回声增强,分布不均匀,内可见多个低回声区,较大的约为2.3 cm×2.0 cm,边界尚清。     

累及右侧心腔的静脉内平滑肌瘤病(附2例报告)

目的探讨累及右侧心腔的静脉内平滑肌瘤病的诊断和治疗方法。方法对2例累及右侧心腔的静脉内平滑肌瘤病患者采用腹部B超和心脏超声、增强CT等检查。手术治疗官分期进行,一期行心脏及下腔静脉肿瘤切除术,二期于术后1个月行子宫切除并盆腔清扫术。结果2例患者手术均获成功,1例随访3年,另1例随访4．5年,均存活。结论累及右侧心腔的静脉内平滑肌瘤病罕见,详尽的术前检查、分期手术切除以及相关学科的协作是根治本病的关键。     

伴有心脏受累的静脉内平滑肌瘤病一例

静脉内平滑肌瘤病是一种特殊类型的子宫肌瘤,其生长方式类似恶性肿瘤,达下腔静脉甚至累及右心腔者非常罕见,具有潜在的致命性.本文报道1例伴有心脏受累的静脉内平滑肌瘤病患者.患者41岁,女性,因"间断右上腹疼痛,伴双下肢轻度肿胀20天"入院.既往有子宫肌瘤及子宫次全切除病史.超声心动示:右心房内可见团块,与心腔无黏连,左室射血分数60.00%.腹部CT示:下腔静脉全程、左侧髂总、髂内静脉内软组织肿物,病变卜极达右心房,增强扫描示肿物有明显强化.妇科及盆腔血管彩超可见下腔静脉下段、左侧髂总静脉内占位,左侧附件区髂内、外静脉之间可见一分叶状团块,其内见营养血管,子官次全切除术后.初步诊断:下腔静脉、右心房肿瘤.行胸腹联合心脏、下腔静脉伞程肿瘤切除,左侧髂内静脉结扎术,术后未予激素治疗,病理示肿瘤细胞呈梭形,未见核分裂相,无凝固性坏死,免疫组化SMA(+++),desmin(+),PR(+),ER(+),S100(-),CD117散在个别细胞(+),CD34(-),Ki67<50%.随访6个月未见肿瘤复发.该病临床表现无特异性,术前诊断率低,确诊主要依靠病理,鉴别心脏、下腔静脉原发肿瘤和血栓后,临床治疗主要是肿瘤彻底手术切除,术后短期未见复发.     

Intravenous leiomyomatosis with right heart involvement-a report of 4 cases and literature review

Intravenous leiomyomatosis(IVL) is a rare benign neoplasm which originates from the smooth muscle cells and is usually confined to the pelvic venous system.Rarely,intracaval and intracardiac extension has been described.Death can occur as a result of intracardiac involvement.We reported 4 cases of IVL with right heart involvement(intracardiac leiomyomatosis,ICL).Three of them suffered recurrent sudden syncope,and the other one was totally asymptomatic.All of them were successfully treated through one-stage operation under extracorporeal circulation.     

Diagnosis and surgical treatment of intraveneous leiomyomatosis extending into the heart: two cases report and review of the literature

Objective

To investigate the clinical characteristics, diagnosis and surgical treatment of intravenous leiomyomatosis (IVL), and outline the differences between Chinese and overseas cases.

Methods

Clinical data of two IVL cases, treated in our hospital, were analyzed retrospectively and the related literature was also reviewed. The data of preoperative diagnostic rate, surgical procedures, and postoperative recurrence between patients in China and other countries were compared.

Results

The first stage operation was performed successfully in 2 patients. However, they refused subsequent therapies, including a second stage operation to excise the remnants of the tumor, uterus, bilateral oviducts and ovaries, and anti-estrogen therapy. Both suffered from IVL recurrence, one at 6-month and the other at 9-month, and died at 16-month and 12-month respectively after the first stage surgery. Worldwide reports of 110 IVL cases were reviewed, which included 28 cases in China and 82 cases in other countries. In the majority of the Chinese patients, tumors only extended into the right atrium rather than the right ventricle (RA 22 cases vs RV 4 cases). However, among the overseas patients, the rate of extension into the right atrium was similar to that of extension into the right ventricle (RA 41 cases vs RV 38 cases). The rate of hysterectomies was not significantly different between Chinese and overseas patients (67.86% vs 55.9%, P=0.278). The rate of correct preoperative diagnosis in the Chinese patients was significantly lower than that in the overseas patients (32.14% vs 80%, P=0.000002), as well as the rate of complete excision of the tumor (22.7% vs 75.5%, P=0.000001). The proportion of patients who undergoing a single-stage or a two-stage operation was similar in Chinese and overseas patients. The recurrence rate was significantly higher in the Chinese patients than in the overseas patients (36.8% vs 9.1%, P=0.0055), and the patients with tumor recurrence were partial tumor excision patients.

Conclusion

The possibility of IVL should be considered if echocardiography in female patients demonstrates a tumor in the right heart and a mass in the inferior vena cava (IVC). Further imaging should be performed to confirm the diagnosis. The correct diagnosis and accurate preoperative delineation of tumor extension are essential for an optimal surgical outcome. The key point in IVL treatment is the complete excision of tumors (single-stage or two-stage surgical procedure).     

子宫血管肉瘤2例报告并文献复习

目的 分析2例起初被误诊为其他类型子宫恶性肿瘤的子宫血管肉瘤病例并复习相关文献,以提高临床医生对其临床病理特征、治疗和预后的认识。 方法 收集并分析山东大学齐鲁医院妇科收治的2 例子宫血管肉瘤患者的临床资料,结合相关文献对该疾病进行总结。 结果 病例1接受了根治性手术,术后给予异环磷酰胺+表柔比星方案化疗6个周期,术后无进展生存期为62个月,总生存期为66个月;病例2接受了根治性手术,术后给予异环磷酰胺+表柔比星方案化疗4个周期,尚无复发迹象。 结论 子宫血管肉瘤临床上极为罕见,易被误诊,诊断时应借助病理及免疫组化与其他子宫恶性肿瘤相鉴别,手术联合术后辅助化疗可能是子宫血管肉瘤一种有效的治疗方法。