一例恶性潜能未定的子宫平滑肌瘤患者的病例分析

A Case Report of a Patient with Uterine Smooth Muscle Tumor of Uncertain Malignant Potential

摘要: 前言：恶性潜能未定的子宫平滑肌瘤(Uterine smooth muscle tumor of uncertain malignant potential, STUMP)由于其高度的异质性，通常被认为是从平滑肌瘤向平滑肌肉瘤的过渡。虽然大多数研究表明恶性潜能未定的子宫平滑肌瘤(STUMP)的特点是生长较慢，通常延迟复发，但与平滑肌肉瘤相比预后较好。仍然有一些案例以其恶性的生物行为而闻名。病例报告：我们报告一位43岁的女性患者，在外院首次接受腹腔镜下子宫肌瘤切除术8年后，表现为由于巨大的腹腔转移引起的剧烈腹痛伴肿瘤破裂出血在我院接受治疗。在这期间患者反复复发并进行多次手术治疗，并在最近一次手术中高度怀疑恶性潜能不确定的平滑肌肿瘤(STUMP)发生向平滑肌肉瘤转变。我们成功地进行了腹腔及腹壁肿物切除术和腹腔热灌注治疗术。术后组织病理诊断：符合恶性潜能未定的平滑肌肿瘤(STUMP)以高级别平滑肌肉瘤发生恶变。结论：由于这种肿瘤的罕见，其病因、预后因素、临床结果和复发风险尚不清楚。这些肿瘤一旦复发，可能会有侵袭性的临床病程，与局部和远程复发甚至死亡有关。因此，被诊断为恶性潜能未定的子宫肌瘤的患者应接受长期监测。

Abstract: Introduction: Recurrent Uterine smooth muscle tumors of uncertain malignant potential (STUMP) are generally identified as a transition from leiomyoma to leiomyosarcoma due to its high heterogeneity. Although most studies have shown that STUMP is characterized by slower growth and usually delayed recurrence, its prognosis is better than leiomyosarcoma. There are still some cases that are known for their vicious biological behavior. Case report: We report the case of a 43-year-old woman patient who presented at our hospital with severe abdominal pain due to an enormous abdominal metastasis and tumor rupture hemorrhage 8 years after initial laparoscopic myomectomy in another hospital. During this period, the patient repeatedly relapsed and underwent multiple surgical treatments, and the transition to leiomyosarcoma of the highly suspected STUMP occurred in the most recent surgery. Resection of abdominal and abdominal wall masses and peritoneal thermal perfusion were performed successfully. Postoperative histopathological diagnosis: The malignant transformation of high-grade leiomyosarcoma occurred in STUMP patients with undetermined malignant potential. Conclusion: Due to the rarity of this tumor, its etiology, prognostic factors, clinical outcome, and risk of recurrence remain unknown. Once these tumors recurred, they may have an aggressive clinical course that is associated with local and distant recurrence and even death. Therefore, patients diagnosed with STUMP should receive long-term monitoring.