子宫内膜癌脑转移的临床病理分析

目的:回顾性分析子宫内膜癌脑转移患者的临床病理特征，评估早期诊断脑转移并积极给予治疗对于预后的价值。方法:我们回顾性分析并观察2015年至2017年在南京鼓楼医院确诊的3例子宫内膜癌脑转移的病人，总结其临床症状、诊断、病理学形态和免疫组化表型特征、生物学特征及其治疗、疗效及预后等临床病理特征，并对照子宫内膜癌脑转移的相关文献报道，对其临床病理特点及治疗预后进行总结分析。结果:3例子宫内膜癌病例初治时均为早期子宫内膜样腺癌，组织学分级2例为3级，1例为2级，其中2例Ia期患者术后未接受任何辅助治疗，1例II期患者行了术后辅助化疗及同步放化疗。3例患者分别在发病60个月、12个月、32个月时发现脑转移，1例为小脑转移，2例为顶叶转移，其中有2例伴有颅外其他部位转移。确诊脑转移后1例行了手术+TOMO（螺旋断层精确放射治疗），生存期约6个月；1例接受了IMRT（调强适形放疗），现已存活6个月至今；1例未治疗，生存期仅12天。结论:子宫内膜癌脑转移发生率低，经过个体化多模式综合治疗可以有效地控制脑部转移病灶，缓解患者临床症状并延长患者的生存期。

Clinicopathological study of brain metastasis in patients with endometrial carcinoma

Objective:To observe the clinicopathological characteristics including diagnosis,biological characteristics,disease course and treatment of endometrial carcinoma patients with brain metastasis,review the literature and evaluate the treatment which could prolong the survival.Methods:We observed patients with endometrial carcinoma and brain metastases from 2015 to 2017 in Nanjing Drum Tower Hospital,and the clinical characteristics,pathological morphology and immunohistochemical phenotypic characteristics,the treatment options and clinical outcome were analyzed.Results:Three cases of endometrial carcinoma were all endometrioid adenocarcinoma of the early stages at the initial diagnosis,and the histological grade of 2 cases was grade 3 and 1 was grade 2.Two patients with stage Ia were not treated with any adjuvant therapies.One patient with stage II received postoperative adjuvant chemotherapy followed by concurrent chemoradiotherapy according to the NCCN guide.The three patients were found to have brain metastases at 60 months,12 months and 32 months,respectively,and all of them had obvious neurological symptoms.One case had cerebellar metastasis.Two cases had cerebral metastasis,and 2 cases had extracranial metastasis.After diagnosis of brain metastases,1 patient reveived surgery and TOMO radiotherapy,with a survival time of 6 months.1 patient was treated with IMRT radiotherapy,and survived till now.1 patient was untreated and the survival time was 12 days.Conclusion:The incidence of brain metastases in endometrial carcinoma is low.Individualized multimode comprehensive treatments can effectively control the tumor load,relieve clinical symptoms and prolong the survival time of patients.