子宫分割性平滑肌瘤一例并文献复习

doi:10.12280/gjszjk.20220174

摘要/Abstract

摘要：

子宫分割性平滑肌瘤是一种罕见的良性平滑肌瘤,生长方式特殊,临床症状及辅助检查常无特殊表现,需要术后病理确诊,免疫组织化学进一步证实。回顾性分析1例子宫分割性平滑肌瘤的临床资料,该患者为围绝经期女性,每年体检子宫肌瘤逐渐增大并伴有月经量增多,盆腔超声及磁共振成像为子宫平滑肌瘤,肿瘤标志物正常,行经腹子宫肌瘤剔除术,术后病理确诊为子宫分割性平滑肌瘤。

关键词: 平滑肌瘤, 子宫, 病例报告, 子宫分割性平滑肌瘤

Abstract:

Dissecting leiomyoma of the uterus is a rare benign leiomyoma with the special growth pattern, no special clinical symptoms and no special manifestations in supplementary examinations. The definite diagnosis requires the postoperative pathology and further immunohistochemical examination. We reported a case of dissecting leiomyoma of the uterus, and retrospectively analyzed the clinical data. In this case, the patient was a perimenopausal female and her annual physical examinations showed that the uterine leiomyoma gradually grew, accompanied by excessive menstruation. Pelvic ultrasound and magnetic resonance imaging results showed uterine leiomyoma with normal tumor markers. Transabdominal myomectomy was performed, and the postoperative pathological diagnosis was dissecting leiomyoma of the uterus.

Key words: Leiomyoma, Uterus, Case reports, Dissecting leiomyoma of the uterus

刘帅, 刘君, 张红凯, 朱梅. 子宫分割性平滑肌瘤一例并文献复习[J]. 国际生殖健康/计划生育, 2022, 41(5): 396-399.

LIU Shuai, LIU Jun, ZHANG Hong-kai, ZHU Mei. Dissecting Leiomyoma of The Uterus: A Case Report and Literature Review[J]. Journal of International Reproductive Health/Family Planning, 2022, 41(5): 396-399.

图/表 4

图1 2021年12月24日盆腔MRI图像注：子宫体积增大,外形不规则,局部隆起,其内信号不均,可见多发大小不一类圆形混杂信号区,最大约8.7 cm×8.4 cm×7.3 cm,与子宫肌层相比,T1WI为等/略低信号,T2WI为低信号,DWI/ADC可见弥散受限。

图2 2022年1月7日盆腔B超图像注：子宫大小10.8 cm×11.8 cm×8.9 cm,最大肌瘤8.2 cm×9.2 cm×6.9 cm,其内血流丰富。

图3 子宫分割性平滑肌瘤术后大体标本注：标本固定后呈灰黄色。

图4 子宫分割性平滑肌瘤术后病理图（HE×200）注：分化良好的平滑肌细胞呈编织状或漩涡样排列,形成大小不等结节,向周围正常肌层内不规则生长,结节周围间质水肿,见薄壁血管。

参考文献 20

[1]	Kurman RJ, Carcangiu ML, Herrington CS, et al. WHO classification of tumours of female reproductive organs[M]. Lyon: IARC Press, 2014.
[2]	陈晓端. 子宫平滑肌肿瘤的病理学[J]. 现代实用医学, 2004, 16(8):441-443.
[3]	David MP, Homonnai TZ, Deligdish L, et al. Grape-like leiomyomas of the uterus[J]. Int Surg, 1975, 60(4):238-239. pmid: 1123281
[4]	Roth LM, Reed RJ, Sternberg WH. Cotyledonoid dissecting leiomyoma of the uterus. The Sternberg tumor[J]. Am J Surg Pathol, 1996, 20(12):1455-1461. doi: 10.1097/00000478-199612000-00004. doi: 10.1097/00000478-199612000-00004 pmid: 8944038
[5]	张晶, 李全荣, 武艳霞, 等. 39例子宫绒毛叶状分割性平滑肌瘤的荟萃分析[J]. 现代肿瘤医学, 2011, 19(10):2063-2066. doi: 10.3969/j.issn.1672-4992.2011.10.53. doi: 10.3969/j.issn.1672-4992.2011.10.53
[6]	徐靖, 贾相奇, 陈文倩, 等. 子宫分割性平滑肌瘤1例[J]. 中国现代医药杂志, 2021, 23(1):82-83. doi: 10.3969/j.issn.1672-9463.2021.01.021. doi: 10.3969/j.issn.1672-9463.2021.01.021
[7]	曹泽毅. 中华妇产科学[M]. 2版. 北京: 人民卫生出版社, 2004:2082-2089.
[8]	詹阳, 潘静, 谷玉春, 等. 子宫肌壁间小叶样分割性平滑肌瘤5例临床病理分析[J]. 诊断病理学杂志, 2017, 24(1):3-6,10. doi: 10.3969/j.issn.1007-8096.2017.01.001. doi: 10.3969/j.issn.1007-8096.2017.01.001
[9]	徐惠成, 梁志清. 容易误诊为子宫肉瘤的肌瘤类型[J]. 实用妇产科杂志, 2012, 28(1):17-19. doi: 10.3969/j.issn.1003-6946.2012.01.009. doi: 10.3969/j.issn.1003-6946.2012.01.009
[10]	Smith CC, Gold MA, Wile G, et al. Cotyledonoid dissecting leiomyoma of the uterus: a review of clinical, pathological, and radiological features[J]. Int J Surg Pathol, 2012, 20(4):330-341. doi: 10.1177/1066896912450315. doi: 10.1177/1066896912450315 pmid: 22710314
[11]	Buonomo F, Bussolaro S, Fiorillo CA, et al. The Management of the Cotyledonoid Leiomyoma of the Uterus: A Narrative Review of the Literature[J]. Int J Environ Res Public Health, 2021, 18(16):8521. doi: 10.3390/ijerph18168521. doi: 10.3390/ijerph18168521 URL
[12]	Lenz J, Chvátal R, Konečná P. Dissecting leiomyoma of the uterus with unusual clinical and pathological features[J]. Ceska Gynekol, 2020, 85(3):197-200.
[13]	Rocha AC, Oliveira M, Luís P, et al. Cotyledonoid Dissecting Leiomyoma of the Uterus: An Unexpected Diagnosis After Delivery[J]. Acta Med Port, 2018, 31(4):223-227. doi: 10.20344/amp.8707. doi: 10.20344/amp.8707 URL
[14]	刘爽, 吴青青, 詹阳. 子宫小叶样分割性平滑肌瘤的超声特征分析[J]. 中华医学超声杂志(电子版), 2018, 15(2):119-124. doi: 10.3877/cma.j.issn.1672-6448.2018.02.008. doi: 10.3877/cma.j.issn.1672-6448.2018.02.008
[15]	王新莲, 何悦明, 罗静, 等. 子宫绒毛叶分割性平滑肌瘤一例[J]. 临床放射学杂志, 2011, 30(6):927.
[16]	高霭峰, 崔秀娟, 李丹. 子宫绒毛叶状分割性平滑肌瘤3例临床病理分析[J]. 中国医科大学学报, 2007, 36(5):598-599,603. doi: 10.3969/j.issn.0258-4646.2007.05.036. doi: 10.3969/j.issn.0258-4646.2007.05.036
[17]	蒋洪棉, 黎春莹, 朱世龙, 等. 子宫分割性平滑肌瘤1例临床病理分析[J]. 临床与实验病理学杂志, 2019, 35(5):579-581. doi: 10.13315/j.cnki.cjcep.2019.05.021. doi: 10.13315/j.cnki.cjcep.2019.05.021
[18]	谢幸, 孔北华, 段涛. 妇产科学[M]. 9版. 北京: 人民卫生出版社, 2018:311.
[19]	邓波儿. 子宫平滑肌肉瘤诊治进展[J]. 肿瘤学杂志, 2018, 24(5):504-508. doi: 10.11735/j.issn.1671-170X.2018.05.B019. doi: 10.11735/j.issn.1671-170X.2018.05.B019
[20]	吕亮芬. 子宫平滑肌肉瘤的临床特点及治疗预后分析[J]. 中国继续医学教育, 2019, 11(15):100-102. doi: 10.3969/j.issn.1674-9308.2019.15.042. doi: 10.3969/j.issn.1674-9308.2019.15.042