LEIOMYOSARCOMA IN A SERIES OF HYSTERECTOMIES PERFORMED FOR PRESUMED UTERINE LEIOMYOMAS
LEIOMYOSARCOMA IN A SERIES OF HYSTERECTOMIES PERFORMED FOR PRESUMED UTERINE LEIOMYOMAS
复制标题
DOI：
10.1016/0002-9378(90)91298-q
复制
发表时间：
1990-04-01
影响因子：
9.8
通讯作者：
SCHLAERTH, JB
中科院分区：
文献类型：
--
作者：
LEIBSOHN, S;DABLAING, G;SCHLAERTH, JB
子宫平滑肌瘤中平滑肌肉瘤的发生率估计在0.13 - 0.29%之间。然而，术前诊断为良性子宫平滑肌瘤而切除的子宫平滑肌肉瘤的确切发生率以前没有报道。1983年至1988年间，妇女医院共有1432名病人，他们都是自称贫困的人群，由于子宫平滑肌瘤引起的异常子宫出血或腹痛，或由于认为子宫的大小或性质足以保证手术探查的盆腔肿块，计划进行子宫切除术。这些妇女的年龄从36岁到62岁不等，子宫切除标本中平滑肌肉瘤的存在从40岁到70岁稳步增加（分别为0.2%，0.9%，1.4%和1.7%）。8例患者术前进行子宫内膜组织学检查。8例患者中有3例术前组织诊断为平滑肌肉瘤，临床上仅限于子宫。1429例良性子宫切除术后，病理诊断平滑肌肉瘤7例（0.49%）。在这7例患者的子宫内膜取样中没有发现恶性肿瘤的证据，只有3例在术中怀疑诊断。术前子宫大小为8 - 20周妊娠大小，术后子宫重量为120 - 1100 g。10例患者中有7例出现异常子宫出血症状。年龄在40 - 60岁之间，1%（8/817）的妇女假定子宫平滑肌瘤产生的症状，需要子宫切除术后诊断为平滑肌肉瘤。促性腺激素释放激素激动剂，子宫内膜消融术，子宫肌瘤切除术或剖腹手术，而不是子宫切除术在这些妇女的治疗可能会延迟平滑肌肉瘤的诊断和明确的治疗。
The incidence of leiomyosarcoma in uterine leiomyomas is estimated to be between 0.13 to 0.29%. However, the exact incidence of leiomyosarcoma in uteri removed with a preoperative diagnosis of benign uterine leiomttomas has not been previously reported. Between 1983 and 1988, a total of 1432 patients in Women''s Hospital, a self-referred indigent population, had a hysterectomy planned because of abnormal uterine bleeding or abdominal pain associated with the presence of uterine leiomyomas, or because of a pelvic mass thought to be uterine sufficient size or character to warrant surgical exploration. The ages of these women ranged from 36 to 62 years and the presence of leiomyosarcoma in the hysterectomy specimens increased steadily from the fourth to seventh decades of age (0.2%, 0.9%, 1.4%, and 1.7%, respectively). Preoperative histologic examination of the endometrium was performed in eight patients. Three of the eight patients had a preoperative tissue diagnosis of leiomyosarcoma that was clinically confined to the uterus. After the hysterectomy in the 1429 patients with presumed benign disease, histologic diagnosis of leiomyosarcoma was made in seven (0.49%). There was no evidence of malignancy in the endometrial sampling of any of these seven patients and the diagnosis was suspected intraoperatively in only three. Preoperative uterine size ranged from 8 to 20 weeks'' gestational size and postoperative uterine weight ranged from 120 to 1100 gm. Seven of the 10 patients had symptoms of abnormal uterine bleeding. Between the ages of 40 and 60 years, 1% (8 of 817) of women with presumed uterine leiomyomas producing symptoms that necessitated hysterectomy in this series had leiomyosarcoma diagnosis postoperatively. Such treatments as gonadotropin-releasing hormone agonists, endometrial ablation, myomectomy by hysteroscopy or laparotomy instead of hysterectomy in such women could delay the diagnosis and definitive treatment of leiomyosarcoma.