子宫平滑肌肉瘤伴广泛腹腔播散1例 并文献复习

Uterine Leiomyosarcoma with Extensive Peritoneal Dissemination: A Case Report and Literature Review

摘要: 目的：探讨子宫平滑肌肉瘤(uterine leiomyosarcoma, uLMS)伴广泛腹腔播散的临床特点、诊断难点、诊疗策略及预后，提高临床对该病的早期识别与规范化诊疗水平。方法：回顾性分析1例51岁子宫平滑肌肉瘤伴腹腔广泛播散患者的临床资料、影像学、穿刺病理、术中所见及术后病理结果，并结合相关文献进行复习。结果：患者因下腹痛1年入院，CA125轻度升高，影像学提示盆腔包块伴腹腔多发占位，术前拟诊卵巢恶性肿瘤；穿刺病理提示平滑肌瘤，术中快速病理示梭形细胞肿瘤，术后常规病理确诊为子宫平滑肌肉瘤(梭形细胞型)，广泛累及子宫、大网膜、肠管、肠系膜、膈肌、肝脏表面、腹壁。予肿瘤细胞减灭术，术后拟行辅助治疗。结论：子宫平滑肌肉瘤临床表现不典型，极易与卵巢癌、播散性子宫平滑肌瘤病混淆，术前诊断困难，确诊依赖术后病理及免疫组化。临床需重视快速增大的盆腔包块、既往肌瘤手术史及腹腔广泛播散病灶的鉴别，遵循无瘤原则，规范手术与综合治疗，改善患者预后。

Abstract: Objective: To explore the clinical characteristics, diagnostic difficulties, diagnosis and treatment strategies, and prognosis of uterine leiomyosarcoma (uLMS) with extensive peritoneal dissemination, and to improve the level of early recognition and standardized diagnosis and treatment of this disease in clinical practice. Methods: The clinical data, imaging findings, puncture pathology, intraoperative observations and postoperative pathological results of a 51-year-old patient with uterine leiomyosarcoma complicated with extensive peritoneal dissemination were retrospectively analyzed, and relevant literatures were reviewed. Results: The patient was admitted to hospital with a one-year history of lower abdominal pain, accompanied by a slight elevation of CA125. Imaging examination suggested a pelvic mass with multiple abdominal space-occupying lesions, and ovarian malignant tumor was suspected preoperatively. Puncture pathology indicated leiomyoma, intraoperative frozen section pathology revealed spindle cell tumor, and postoperative routine pathology confirmed the diagnosis of spindle cell-type uterine leiomyosarcoma, which extensively involved the uterus, greater omentum, intestinal tract, mesentery, diaphragm, liver surface and abdominal wall. The patient underwent cytoreductive surgery, and adjuvant therapy was planned after operation. Conclusion: Uterine leiomyosarcoma has atypical clinical manifestations and is extremely easy to be confused with ovarian cancer and disseminated leiomyomatosis peritonealis. Preoperative diagnosis is difficult, and the definitive diagnosis relies on postoperative pathology and immunohistochemistry. Clinicians should attach importance to the differentiation of rapidly enlarged pelvic masses, previous history of myomectomy, and extensive disseminated abdominal lesions. It is necessary to follow the tumor-free principle, standardize surgical procedures and comprehensive treatment, so as to improve the prognosis of patients.