以腹股沟疝为首发表现的子宫圆韧带原发性腺癌1例并文献复习

Primary Adenocarcinoma of the Uterine Round Ligament Presenting as Inguinal Hernia: A Case Report and Literature Review

摘要: 子宫圆韧带原发性腺癌是临床极为罕见的女性生殖道恶性肿瘤，以腹股沟疝为首发表现时术前误诊率极高。本文报道1例2026年3月我院收治的以右侧腹股沟疝为首发症状的54岁女性患者，术前CT诊断为右侧腹股沟疝，先行腹腔镜腹股沟疝修补术，术中发现疝囊外独立实性肿物，遂中转行肿物完整切除术。术后病理提示纤维组织中腺癌浸润，结合2026年国际中肾管样腺癌(MLA)联盟最新诊断标准，确诊为子宫圆韧带原发性苗勒管源性腺癌，排除真性中肾管腺癌及中肾管样腺癌。患者术后恢复良好，建议完善PET-CT全身评估并转诊妇科肿瘤科行辅助治疗及长期随访。结合文献复习分析表明，本病临床表现缺乏特异性，女性腹股沟区不可还纳的实性肿物需警惕本病可能，术中发现“疝囊外实性肿物”是关键鉴别线索，确诊依赖病理及免疫组化联合检测，治疗首选完整手术切除，术后需重点加强肺部及妇科肿瘤相关随访。

Abstract: Primary adenocarcinoma of the round ligament of the uterus is an extremely rare malignant tumor of the female reproductive tract, and its preoperative misdiagnosis rate is extremely high when it presents initially as an inguinal hernia. This article reports a 54-year-old female patient admitted to our hospital in March 2026 with right inguinal hernia as the initial symptom. Preoperative CT diagnosed right indirect inguinal hernia, and laparoscopic inguinal hernia repair was performed first. Intraoperatively, an isolated solid mass outside the hernia sac was found, and the operation was converted to complete resection of the mass. Postoperative pathology revealed adenocarcinoma infiltration in fibrous tissue. Combined with the latest diagnostic criteria of the International Mesonephric-like Adenocarcinoma (MLA) Consortium in 2026, the patient was diagnosed with primary Müllerian-derived adenocarcinoma of the round ligament of the uterus, excluding true mesonephric adenocarcinoma and mesonephric-like adenocarcinoma. The patient recovered well postoperatively. It is recommended to complete whole-body positron emission tomography-computed tomography (PET-CT) evaluation and refer to the Department of Gynecologic Oncology for adjuvant therapy and long-term follow-up. Combined with literature review and analysis, the clinical manifestations of this disease are non-specific. Irreducible solid masses in the inguinal region of women should raise suspicion of this disease. Intraoperative discovery of a “solid mass outside the hernia sac” is a key differential clue. Diagnosis relies on combined detection of pathology and immunohistochemistry (IHC). Complete surgical resection is the first-line treatment, and emphasis should be placed on strengthening follow-up for pulmonary and gynecologic tumors after surgery.