作　　者： (王海静）; (王悦）; (祝洪澜）; (崔恒）; (李艺）;

机构地区： 北京大学人民医院妇产科,100044 山东省淄博市妇幼保健院妇科

出　　处： 《中国妇产科临床杂志》 2017年第5期388-391,共4页

摘　　要： 目的分析子宫腺肌病恶变的临床及病理学特点。方法回顾性分析北京大学人民医院9例子宫腺肌病恶变患者的临床特点、病理学特征及诊治预后情况。结果患者平均年龄为(48.7±5.1)岁,7例未绝经。主要临床表现为阴道不规则流血。术前都没有获得诊断。术中冰冻病理发现3例腺肌症恶变。恶变类型是子宫内膜样腺癌8例,透明细胞癌1例。免疫组化7例ER(+),6例PR(+),5例P53(+),4例CD10(+)。FIGO分期8例为ⅠA期,1例为ⅠB期。8例行全面分期手术,1例行全子宫+双侧附件切除术。4例采用铂类为基础的联合化疗,1例口服孕激素。8例患者无瘤生存期(60.9±19.8)个月。1例失访。结论子宫腺肌病恶变患者发病较年轻,Ⅰ期患者多。术前诊断困难,术中冰冻病理有一定价值,需要术后病理确诊。治疗参照子宫内膜腺癌和卵巢上皮癌,预后比较好。 Objective To investigate diagnosis and treatment methods for malignant transformation of adenomyosis. Methods A retrospective study was taken out to 9 cases of adenomyosis patients which admitted in Peking University People＇s Hospital and found malignant transformation. The clinical features, pathology results, treatment and prognosis were analyzed. Results The mean age of the patients was （48.7 ~＋ 5.1） years, and 7 cases without menopause. None has particular symptom, the main clinical manifestation was irregular vaginal bleeding. None was diagnosed pre-operation, 3 cases were diagnosed by intraoperative frozen pathology. There were 8 cases of endometrioid adenocarcinoma and 1 case of clear cell carcinoma. The result of immnuohistochemistry showed that 7 cases with ER （＋）, 6 PR （＋）, 5 P53 （＋）, and 4 with CD10 （＋）. 8 cases were diagnosed as FIGO stage Ia, and 1 case Ib. 8 cases received staging operations, 1 case total hysterectomy and bilateral salpingo oophorectomy. 4 cases were treated with platinum based combination chemotherapy, and 1 case with oral progesterone. 8 patients survived without tumor, and the median survival time was （60.9_＋ 19.8） months. 1 case was lost by follow-up. Conclusions The adenomyosis patients with malignant transformation were relatively young, most stage I. Preoperative diagnosis was difficult, the intraoperative frozen pathology was important for diagnosis. The prognosis was good on the whole with the treatment of endometrial adenocarcinoma and ovarian epithelial carcinoma.

关 键 词： 子宫腺肌病 恶变 病理学