子宫腺肌病恶变的研究进展

子宫腺肌病是一种子宫内膜异位性疾病,是妇科常见的良性疾病。子宫腺肌病在某些方面可表现出恶性肿瘤特征,如血管生成与侵袭行为,具有恶变潜能。子宫腺肌病恶变的病理类型以子宫内膜腺癌居多。其发病机制尚不明确,可能与平滑肌细胞异常、高雌激素状态、雌孕激素受体、代谢酶的异常、基因突变及表观遗传学等有关。临床表现不典型,主要症状为异常阴道出血及绝经后阴道出血。子宫腺肌病术前诊断比较困难,特别是早期诊断更为困难,临床上漏诊、误诊率较高,术后病理可诊断此病。治疗以手术为主,辅以放、化疗。预后尚不清楚,有待更多的病例证实。现就子宫腺肌病恶变的研究进展进行综述,旨在为早期诊治提供新思路。

Research Progress on Malignant Transformation of Adenomyosis

Adenomyosis is a kind of common benign gynecologic endometriosis disease, which shows the characteristics of malignant in certain aspects, such as the angiogenesis and invasion behavior, and has the potential of malignant transformation. The main histologic type is endometrioid adenocarcinoma. The pathogenesis may be related to abnormal smooth muscle cells, high estrogen status, female progesterone receptors, metabolic enzyme abnormalities, gene mutation and epigenetics and so on, but remains unclear. The clinic manifestations are not typical. Abnormal vaginal bleeding and vaginal bleeding after menopause are the most common clinical symptoms of malignant transformation of adenomyosis. It is difficult to make a preoperative diagnosis especially an early one, which leads to the high rate of misdiagnoses and the erroneous diagnosis. Postoperative histopathological examination could determine the diagnosis. Surgery combined with chemotherapy and radiotherapy is recommended for the treatment. The prognosis is unknown, which need to be further studied. This article will review the progress on malignant transformation of adenomyosis, intending to provide new way for the early diagnosis and treatment.