Unusual case of adenomyosis of the uterine body with malignant clinical course

We report an unusual case of adenomyosis with asymptomatic thoracic endometriosis. A 30-year old woman had a history of nephroblastoma, two missed abortions and one childbirth by caesarean section. The pregnancy was complicated with asymmetric fetus hipotrophy. Two years after delivery she had assessments for dysmenorrhea, dyspareunia, pelvic pain, and anemia. Gynaecological examination and pelvic endovaginal ultrasonography revealed enlarged uterus. Tumour structure was found with diameter ranging from 40 to 63 mm. The round focus with diameter 15 mm in the left lung by chest roentgenogram was revealed. The patient was diagnosed as follows: hysterography, curettage, bronchoscopy, laparoscopy. Hysterectomy without adnexes was performed and tumour of the left lung was resected. Histologic diagnosis revealed adenomyosis of uterine body and parenchymal pulmonary endometriosis. Two years after operations patient alive without sings of disease.     

子宫动脉栓塞术治疗子宫腺肌病的临床观察

目的探讨子宫动脉栓塞术(uterine artery embolization,UAE)治疗子宫腺肌病的临床疗效。方法选择2003年4月至2006年4月北京仁和医院48例子宫腺肌病患者,以改良的Seldinger s技术完成双子宫动脉超选择插管并栓塞,观察术后1个月、3个月和6个月的疗效。结果 48例患者中,UAE治疗后临床症状全部缓解;患者治疗前活动能力丧失程度、疼痛分级与治疗后比较,差异有统计学意义(P0.01);48例患者术后月经量为术前的(51.2±18.3)%,差异具有统计学意义(P0.01);所有患者贫血改善,术后3个月均恢复正常;术后6个月子宫体积平均缩小46.6%(P0.01),病灶体积平均缩小65.2%(P0.01);卵巢内分泌激素无明显变化(P0.05)。结论 UAE治疗子宫腺肌病近期疗效显著,且微创、安全、副反应少。     

46例子宫肉瘤临床病理分析

１９８０年６月至１９９０年６月收治子宫肉瘤４６例，占收治的子宫恶性肿瘤１９２６例的２．３％，其中Ⅰ期１０例、Ⅱ期６例、Ⅲ期２５例、Ⅳ期５例。４６例均有病理证实，其中平滑肌肉瘤２８例，内膜间质肉瘤６例，内膜间质异位症４例，中胚叶混合瘤型５例，癌肉瘤型３例，好发于肌层，光镜下见癌细胞密集，排列紊乱，大小形态不一，核异型性明显，核染色质深，核膜不清，核仁明显，核分裂像多在５／１０ＨＰＬ可见瘤巨细胞及多核瘤巨细胞。治疗以手术为主，辅之以化疗和（或）放疗。     

左炔诺孕酮宫内缓释系统用于防治子宫内膜异位症和子宫腺肌病的临床观察

目的观察左炔诺孕酮宫内缓释系统(LNG-IUS)用于治疗子宫内膜异位症(EM)及子宫腺肌病(AM)相关疼痛和防止复发的疗效。方法EM患者21例,AM患者12例,于保守性手术后即刻,或单纯疼痛复发后放置LNG-IUS,EM患者中有4例在放置前注射促性腺激素释放激素激动剂(GnRHa),AM患者中有5例放置前注射GnRHa。以放置LNG-IUS前后自身对照,比较疼痛视觉模拟评分(VAS)、血清生殖激素和CA125水平,随诊记录阴道出血等副反应的发生情况;放置前注射GnRHa者与单纯放置者比较出血模式的差异。结果疼痛复发后单纯放置LNG-IUS的5例EM患者,VAS评分由放置前的(8·09±0·21)降至(1·64±1·12)分,两者比较,差异有统计学意义(P=0·042);5例单纯放置LNG-IUS的AM患者,VAS评分由(8·41±1·59)降至(3·99±3·87)分,两者比较,差异无统计学意义(P=0·068)。所有患者于随访期限内,仅2例患者分别出现疼痛或病灶复发,其余患者无疼痛或病灶的复发。放置LNG-IUS后有30例患者完成了初次随诊,初次随诊时间平均为5个月,月平均出血天数18·6d,以不规则点滴出血为主;放置LNG-IUS前是否加用GnRHa的患者月平均出血天数分别为(19±6)和(18±6)d,两者比较,差异无统计学意义(P=0·089)。随诊满1年时,22例患者转为每月规律性阴道出血,月平均出血天数8d。结论LNG-IUS能有效控制EM和AM相关疼痛并延缓复发,不规则和(或)点滴阴道出血是最显著的副反应,放置前注射GnRHa对出血的改善效果欠佳。     

子宫腺肌症318例诊治分析

目的 分析近年来子宫腺肌症的发病情况、临床表现、诊断和治疗。方法 回顾性分析1997年1月～1999年12月本院收治的318例子宫腺肌症患者的临床资料。结果 318例子宫腺肌症占我院同期妇科住院人数的5.7％、妇科手术子宫切除的20.9％。术前痛经者217例(68.2％),月经过多者132例(41.5％);术前诊断为子宫腺肌症192例,诊断符合率为60.4％,B超诊断符合率为60.5％,血CA125测定阳性率为72.3％。除2例行腺肌瘤剔除术外,全部患者均行子宫切除术,其中33例术前曾使用内美通、丹那唑、米非司酮、雌孕激素类及雄激素等治疗达3个月以上,80.0％痛经明显缓解,但75.0％患者停药后第1个月经周期痛经即复发。结论子宫腺肌症目前仍以手术治疗为主,治疗子宫内膜异位症的常用药物对子宫腺肌症痛经均有效,但停药后腺肌症患者痛经易复发。     

基质金属蛋白酶基因启动子区基因多态性与子宫内膜异位症遗传易感性的相关性研究

目的探讨基质金属蛋白酶（MMP）1、3启动子区基因多态性与子宫内膜异位症和子宫腺肌病遗传易感性的相关性。方法采用聚合酶链反应限制性片段长度多态性（PCR—RFLP）方法,分析1（30例子宫内膜异位症患者（内异症组）、80例子宫腺肌病组患者（腺肌病组）和150例健康妇女（对照组）MMP-1和MMP-3基因型及等位基因频率分布。结果（1）MMP-1中2G等位基因频率在内异症组和腺肌病组患者中分别为79．0％（158／200）和79．4％（127／160）,明显高于对照组（67．0％,201／300）,差异有统计学意义（P〈0．01）;3组中1G／1G、1G／2G、2G／2G3种基因型频率分布比较,差异也有统计学意义（P〈0．05）。2G／2G基因型或2G／2G＋1G／2G基因型均能增加内异症的患病风险,经年龄校正的风险值分别为3．65（95％CI=1．41—9．43）和3．25（95％CI=1．29～8．23）;2G／2G基因型可显著增加腺肌病的患病风险,经年龄校正的风险值为2．55（95％CI=1．03—6．33）。（2）MMP-3中5A、6A等位基因频率在内异症和腺肌病组患者中分别为14．0％（28／200）、86．0％（172／200）和15．6％（25／160）、83．4％（135／160）,与对照组（20．3％、79．7％）比较,差异无统计学意义（P〉0．05）;5A／5A、5A／6A、6A／6A基因型频率分布在3组中比较,差异也无统计学意义（P〉0．05）;与6A／6A基因型相比,5A／5A＋5A／6A基因型不增加内异症和腺肌病的患病风险。（3）MMP-1和MMP-3基因单体型分析结果显示,2G／6A基因单体型明显增加内异症的患病风险,但不增加腺肌病的患病风险。结论MMP-1基因启动子区2G等位基因的存在,可明显增加异位症和腺肌病的患病风险;MMP-3基因启动子区基因多态性与这两种疾病的患病风险无关,但2G／6A单体型可作为异位症患病风险的分层标记。     

Adenocarcinomas arising from uterine adenomyosis: a report of four cases.

Adenocarcinomas arising from adenomyosis uteri are rare. This study reports four such cases and characterizes them clinically and microscopically. In all four patients, the endometrial cytology was negative, and MR imaging and ultrasound sonography did not detect the tumors preoperatively. The histological subtypes of the four tumors were endometrioid (one grade 1, one grade 3), serous, and clear cell. In three cases, the adenocarcinomas were present exclusively in the myometrium, and a transition between the carcinomas and the adenomyotic glands was observed in all cases. The eutopic endometrium was normal except in one case in which there was a small focus of invasive carcinoma. In two of four cases, pelvic or paraaortic lymph node metastases were present. In the carcinomas, ER immunoreactivity was not found in any tumor and PR positivity was found in only one tumor. In contrast, p53 immunopositivity was found in three of four carcinomas. Adenocarcinomas arising from adenomyosis are difficult to diagnose preoperatively, and their aggressive behavior in some cases seems to be related to the histological subtype.     

Clinicopathologic study of adenosquamous carcinoma of the uterine cervix

The 22 adenosquamous carcinoma cases were studied clinicopathologically. The tumor provides many difficulties such as: rapid spreading properties, delayed detection as advanced carcinoma because of the presence of endophytic growth, frequent prevalence of vessel permeation, and radioresistance. Adenosquamous carcinoma was categorized histochemically and histomorphologically into two types--adenosquamous carcinoma (AC) and mucoepidermoid carcinoma, with a comparison being given. As a result, adenosquamous carcinoma (AC) was found inferior to mucoepidermoid carcinoma in radiosensitivity and prognosis, so that categorization into the two types has been considered to be clinically meaningful.     

散结镇痛胶囊对子宫内膜异位症及子宫腺肌病痛经治疗效果观察

目的评价散结镇痛胶囊对子宫内膜异位症及子宫腺肌病痛经的临床治疗价值。方法以2008年12月至2009年3月北京协和医院收治的61例主诉中重度痛经症状的子宫内膜异位症和子宫腺肌病患者为研究对象,45例进入研究组(给予散结镇痛胶囊治疗),16例进入对照组(给予非甾体抗炎药治疗),进行前瞻性对照研究。结果研究组用药后痛经症状完全缓解8例,部分缓解30例,无效7例,有效率84.4%;对照组痛经完全缓解0例,部分缓解6例,有效率37.5%,两组相比差异有统计学意义(P<0.05)。两组子宫体积大小无明显变化。结论散结镇痛胶囊能有效缓解子宫内膜异位症和子宫腺肌病患者的痛经症状,副反应小。     

Uterus didelphys with cervical agenesis associated with adenomyosis,a leiomyoma and ovarian endometriosis. A case report

BACKGROUND: Elevated level of serum CA-125 was detected in a 48-year-old woman who was diagnosed with a lateral fusion defect in association with congenital agenesis of the uterine cervix. This unusual case combined two developmental anomalies of the müllerian duct. CASE REPORT: A 48-year-old woman consulted our outpatient department due to persistent abdominal pain for six months. Bimanual pelvic examination showed absence of the cervix, an anteverted uterus and a 6-cm, left adnexal mass. Ultrasound and computed tomography revealed a uterus didelphys with a 3-cm cystic mass over the right ovary. Serum level of CA-125 was 641.4 U/mL. The patient underwent exploratory laparotomy, and total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Pathology confirmed adenomyosis and a leiomyoma of the uterus with functional endometrium in conjunction with endometriosis of the right ovary. CONCLUSION: Multiple müllerian anomalies associated with adenomyosis and endometriosis should be considered in patients presenting with primary amenorrhea. Thorough evaluation, careful planning, fertility preservation and postoperative outcomes should be reviewed.