子宫内膜中肾样腺癌1例

A Case of Endometrial Mesonephric-Like Adenocarcinoma

摘要: 子宫内膜中肾样腺癌(Endometrial Mesonephric-Like Adenocarcinoma, MLA)是2020版WHO女性生殖系统肿瘤新增的罕见子宫内膜癌亚型，恶性度高、侵袭性强、临床误诊率高。本文报道1例54岁绝经后子宫内膜中肾样腺癌罕见病例。患者术前影像学提示宫腔占位合并类似肌瘤样改变，无肥胖、糖尿病等传统子宫内膜癌高危因素；术中快速病理仅高度怀疑子宫内膜样腺癌，依靠术后全套免疫组化最终确诊MLA。术后病理证实肿瘤深肌层浸润，伴广泛脉管癌栓、浆膜、宫颈、宫旁、单侧附件受累及盆腔淋巴结转移(IIIC1期)。结合文献复习提示：针对绝经后异常出血、术前影像学难以定性甚至倾向良性的子宫占位，临床应警惕MLA这类罕见亚型；术中冰冻病理存在局限性，必须依靠术后完整免疫组化才能实现精准诊断；该肿瘤侵袭转移能力强，确诊后应尽早实施含手术、放疗、化疗的充分综合治疗，做好长期随访。

Abstract: Endometrial mesonephric‑like adenocarcinoma (MLA) is a rare subtype of endometrial carcinoma newly categorized in the 2020 WHO classification of female genital tract tumors, characterized by high malignancy, strong invasiveness and high clinical misdiagnosis rate. T This article reports a rare case of renal adenocarcinoma in the endometrium of a 54-year-old postmenopausal woman. Pre‑operative imaging suggested intrauterine lesion mimicking uterine leiomyoma, without classic risk factors such as obesity or diabetes. Intra‑operative frozen section only raised suspicion of endometrioid adenocarcinoma. Pre‑operative imaging of the patient suggested intrauterine space‑occupying lesion with leiomyoma‑like changes. The patient had no traditional high‑risk factors for endometrial carcinoma such as obesity or diabetes. Intraoperative frozen section pathology only highly suggested endometrioid adenocarcinoma, and the final diagnosis of MLA was established relying on the complete postoperative immunohistochemical panel. Final pathological stage was IIIC1, with deep myometrial invasion, extensive lymphovascular invasion, serosal, cervical, parametrial and adnexal involvement as well as pelvic lymph‑node metastasis. Literature review indicates that rare neoplasm such as MLA should be alerted for post‑menopausal patients with indeterminate or even benign‑looking uterine lesions. Intra‑operative frozen biopsy has diagnostic limitations, and comprehensive postoperative immunohistochemistry is mandatory for accurate subtyping. Given its aggressive biological behavior, prompt multimodality therapy including surgery, radiotherapy and chemotherapy as well as long‑term surveillance are recommended after diagnosis.