子宫平滑肌肉瘤：附11例临床病理分析

Leiomyosarcoma of the uterus--a clinicopathologic analysis of 11 cases

Eleven patients with leiomyosarcoma of the uterus are analysed clinicopathologically. The youngest patient was 36 and the oldest was 61 with a mean of 50.8 years. The common clinical symptoms were menorrhagia or irregular vaginal bleeding, lower abdominal pain and rapidly enlarging abdominal mass. None was diagnosed before operation for lack of specific symptoms. All tumors with 10 or more mitotic figures (MF) per 10 high-power fields (HPF) were diagnosed as malignant whereas for those with less than 10 MF/10 HPF the diagnosis of uterine leiomyosarcoma must depend on cellular pleomorphism, number of giant cells, increase in nuclear-cytoplasmic ratio and presence or absence of boundary between the tumor and normal tissue. The main treatment was total hysterectomy and bilateral salpingo-oophorectomy. The 2- and 5-year survival rates were 36.3% and 27.3%, respectively. Five cases with Stage III and IV lesions died within 11 months after operation. The clinical stage at the initial treatment is the most important prognostic factor. For tumors confined to the uterus, cellular pleomorphism, mitotic figure and boundary between the tumor and normal tissue are the other important prognostic factors.