子宫绒毛叶状分割性平滑肌瘤伴发静脉内平滑肌瘤病(附1例报告)

目的 探讨子宫绒毛叶状分割性平滑肌瘤伴发静脉内平滑肌瘤病的临床及病理学特征。方法 对1例子宫绒毛叶状分割性平滑肌瘤伴发静脉内平滑肌瘤病的病例进行病理学观察、免疫组织化学染色等并复习相关文献。结果 患者42岁,体检B超发现子宫肌层15cm×13cm×10cm大小占位,临床拟诊断子宫肉瘤。肉眼观肌壁内一不规则肿块,向浆膜外突起似胎盘绒毛样外观。镜下肿瘤主要有分化良好的平滑肌细胞、大小不等呈丛状分布的血管组成,周围基质水肿明显。同时在子宫肌层的静脉血管内有形态良好的平滑肌增生,未见超出血管外。手术行子宫及右侧输卵管切除,术后随访6月未复发。结论 子宫绒毛叶状分割性平滑肌瘤伴发静脉内平滑肌瘤病又称为绒毛叶状水泡状静脉内平滑肌瘤病,是一类非常罕见的平滑肌瘤,预后良好。由于奇特的大体外观容易诊断错误导致过度治疗,因此掌握此类良性平滑肌瘤的病理特征以防过度治疗。

Cotyledonoid dissecting leiomyoma of the uterus combined with intravenous leiomyomatosis: 1 case report and literature review

objective To explore the clinical and pathological features of cotyledonoid dissecting leiomyoma of the uterus with intravascular growth. Method 1 cases of cotyledonoid dissecting leiomyoma of the uterus with intravascular growth was observed pathological feature ,immunohistochemical stained and reviewed related literature. Results uterine muscle layers 15cmx13cmx10cm mass was detected with medical ultrasound in a 42-year-old woman and clinical diagnosis of uterine sarcoma. The naked eye uterine muscle layers in a haphazard mass and serous membrane outer protrusions like placental villi-like appearance were discovered, which was composed of well-differentiated tumors of smooth muscle cell and the distribution of the plexiform vascular with prominent hydropic degeneration. In myometrium at the same time form of venous blood tube has good smooth muscle hyperplasia, did not see beyond the blood vessels. The patient underwent total hysterectomy and the right Ssalpingectomy, no recurrence was found during the follow-up of 6 mouths. Conclusion cotyledonoid dissecting leiomyoma of the uterus with intravascular growth, also known as cotyledonoid hydropic intravenous leiomyomatosis(CHIL), is a very uncommon type of a benign uterine smooth-muscle tumor and the prognosis is good. The worrying appearance of the gross specimen is often mistaken for malignant or non-uterine lesions that may result in overtreatment. It is important to be aware of this entity to prevent overly aggressive treatment for this benign smooth-muscle neoplasm.