Current status of the adjuvant therapy in uterine sarcoma: A literature review

Uterine sarcomas (US) are rare mesenchymal tumours accounting approximately for 3%–7% of all uterine cancers. Histologically, US are classified into mesenchymal tumours or mixed epithelial and mesenchymal tumours. The group of mesenchymal tumours includes uterine leiomyosarcoma (uLMS, 65% of cases), endometrial stromal sarcoma (ESS, 21%) – traditionally divided into low grade (LG-ESS) and high grade–undifferentiated uterine sarcoma (5%) and other rare subtypes such as alveolar or embryonal rhabdomyosarcoma. Despite the fact that several drugs demonstrated clinical activity in advanced or metastatic settings, the role of postoperative therapy in US remains controversial. In this review, we have summarised the current state of the art, including the chief trials on adjuvant treatment modalities in US, especially focusing on uLMS, LG-ESS and other rare histotypes.     

11例子宫腺肉瘤的MRI表现及文献复习

目的 总结分析子宫腺肉瘤的MRI表现,以加深对该疾病的认识,提高诊断准确性。 方法 回顾性分析11例经病理确诊为子宫腺肉瘤病人的临床、病理及影像资料,并复习相关文献。分析病灶的部位、大小、边界及MRI信号变化特点,以及表观扩散系数（ADC）值及动态增强时间-信号强度曲线（TIC）。 结果 11例子宫腺肉瘤病人均为单发病灶,MRI显示肿瘤位于子宫腔或宫颈管内,最大径为1.5~12 cm。T₂WI及脂肪抑制（FS）T₂WI上病灶内大部分呈高信号或稍高信号,其中4个呈散在小囊样结构。扩散加权成像（DWI）上8个呈高信号或稍高信号,3个呈中等信号;平均ADC值为（0.94±0.33）×10^-3 mm²/s。增强扫描11个均呈渐进性强化,其中2个呈网格样强化,TIC表现为Ⅰ型6个,Ⅱ型5个。 结论 子宫腺肉瘤的MRI表现具有特征性,对本病的准确诊断有一定帮助。     

10例子宫恶性中胚叶混合瘤临床病理分析

本文报告10例手术切除的子宫恶性中胚叶混合瘤。发病率占同期子宫肉瘤的33％。分析了其临床、病理与预后的关系,认为大体的息肉型、组织学的腺肉瘤预后较好。同源性与异源性预后无差别。治疗应尽早行子宫全切术。     

子宫苗勒氏腺肉瘤临床初探

目的 分析子宫腺肉瘤的临床资料，探讨其治疗方法和预后相关因素。方法 回顾性分析四川大学华西妇产医院1995～2005年收治的8例子宫腺肉瘤病例的临床病理特征、治疗方法和预后。结果 患者年龄27～66岁，平均48岁，绝经前与绝经后分别为3例及5例。主要临床特点为阴道异常流血、下腹痛、子宫增大、官腔内占位及宫颈赘生物等。术前诊断率37．5％；绝经前患者与绝经后患者从出现首发症状到确诊所用时间分别为14个月及8周。组织学特征主要为良性或非典型腺上皮组织伴有肉瘤间质，具有腺周套袖和息肉样突入腺腔的结构。8例均采用手术治疗；7例术后加用化疗。分期早、年轻患者预后好。结论 子宫腺肉瘤临床症状不典型，阴道异常流血常为其首发症状；该病诊断率低，年轻患者易受忽略，但是预后较好；治疗以手术为主，化疗为辅；预后与临床分期、患者年龄有关。     

Malignant Müllerian tumours of the uterus

Summary Thirty-two cases of malignant Müllerian tumours of the uterus of the mixed mesodermal type were investigated. Histological examinations were performed on tissue obtained during curettage or biopsy and/or surgical removal of the uterus; in 4 cases postmortem examination was also carried out. The biphasic tumours of the uterus were classified into four groups and comprised 44% of alle uterine sarcomas. In 10 of the 28 cases in which uterine curettage or cervical biopsy was carried out, the final diagnosis was clarified when the tumorous uterus was removed. The prognosis was poorer for heterologous than for homologous tumours. In the heterologous group, the prognosis was better for the form with chondrosarcomatous features (2 patients are still alive after more than 5 years) than for the form containing striated muscle tissue (all 5 patients died within 1 year). Attention is drawn to the fact that the adenosarcoma should be considered a separate type; its prognosis was relatively good (2 such patients are still alive after more than 5 years).     

浆膜下子宫肉瘤误诊为卵巢恶性肿瘤1例

患者女,43岁,因下腹胀痛1周来院就诊。平素月经规则,5/30天,量中,痛经（-）。末次月经正常。既往无子宫肌瘤及卵巢肿瘤病史。妇科检查：下腹部偏左侧触及较大包块。患者近6个月体质量减轻10余斤,血CA125略高。经阴道和腹部超声：子宫常大,质地欠均;肌层回声欠均匀,隐见内膜,厚度2mm。     

子宫腺肉瘤的CT、MR表现

目的 探讨子宫腺肉瘤的CT、MR特点. 方法 回顾性分析经病理证实的21例子宫腺肉瘤的CT、MR表现.10例接受CT检查,其中7例接受增强CT检查;13例接受MR检查,其中9例接受增强MR检查. 结果 21例患者中,16例(16/21,76.19%)位于子宫体,3例(3/21,14.29%)位于宫颈管,1例(1/21,4.76%)同时位于子宫及宫颈管;1例(1/21,4.76%)位于盆腔.平扫CT 示9例呈不均匀混杂密度影,1例以稍低密度影为主.MR平扫均表现为混杂信号.接受增强扫描的患者中,除3例呈轻度或中等度不均匀强化外,余均呈明显不均匀强化.结论 行增强CT及MRI扫描,结合临床病史及其他检查,可提高子宫腺肉瘤的诊断率,但病理学检查仍为诊断该病的金标准.     

绝经后子宫内膜腺肉瘤致子宫内翻一例并文献复习

绝经后慢性子宫内翻是一种罕见病,报告1例老年女性因子宫内膜腺肉瘤导致子宫内翻,继发感染、尿潴留及静脉血栓栓塞的病例。患者因绝经后阴道出血就诊,期间发现肿物自阴道逐步脱出,经专科查体及影像学检查,考虑是继发于宫底肿物的慢性完全性子宫内翻。病程中患者先后出现感染、尿潴留及左下肢全程静脉血栓栓塞。经多学科会诊,最终于椎管内麻醉下行经腹会阴联合子宫及双附件切除术,术后病理示子宫内膜腺肉瘤,临床拟诊ⅠA期,患者拒绝再分期手术及辅助治疗,术后随访2年无新发肿物。针对该类罕见疾病,结合超声及盆腔磁共振成像典型征象可尽早明确诊断,其治疗需针对原发肿瘤、继发于内翻子宫的并发症及患者自身合并症,制定个体化的围手术期管理方案。     

子宫腺肉瘤与癌肉瘤的MRI表现

目的探讨子宫腺肉瘤和癌肉瘤的MRI特点。方法回顾分析经病理证实的4例宫颈腺肉瘤和2例子宫癌肉瘤的生长方式、肿瘤大小、MRI特征及其强化方式。结果带蒂外生性肿块4例,宽基底外生性肿块2例。肿块最大径5~14 cm（平均9.2 cm）。6例病灶均表现为T2WI,相对于肌层呈不均匀高信号,结合带或宫颈基质不连续伴肌层受侵,肿块内不规则囊变坏死,增强扫描病灶实质部分早期明显强化,后期持续强化。结论宫颈腺肉瘤和子宫癌肉瘤MRI表现相似,特征性表现为外生性肿块伴T2WI不均匀高信号,实质部分明显强化。