Bekkers R L, Massuger L F, Berg P P, Haelst U G, Bulten J
Department of Obstetrics and Gynaecology, Department of Pathology, University Hospital Nijmegen, St. Radboud, Nijmegen, 6500 HB, The Netherlands.
Gynecol Oncol. 1999 Mar;72(3):433-6. doi: 10.1006/gyno.1998.5289.
A case of uterine malignant leiomyoblastoma (UML) which was initially mistaken for uterine leiomyoma on two different occasions is presented. About 20 cases of uterine leiomyoblastoma taking a malignant course have been described in the literature. This case of UML is the first diagnosed during pregnancy. In retrospect, tumor tissue removed from the uterus 4 years earlier already showed histological signs of UML. The large and metastatic tumor showed nuclear atypia, a moderate mitotic index, and tumor cell necrosis, indicating malignancy. Treatment consisted of hysterectomy, bilateral salpingo-oophorectomy, and debulking of most other tumor masses. In the literature, radio- and chemotherapy have not proved to be effective in these tumors. Hormonal therapy has only been used in 2 patients. In this patient, hormonal influence on tumor growth may be substantial. The tumor was progesterone- and estrogen-receptor positive and increased in size rapidly during pregnancy. Since little is known about these tumors further studies are necessary to evaluate hormonal influences both as a causative factor and as a therapeutic possibility.
本文报告一例子宫恶性平滑肌瘤母细胞瘤（UML），该病例在两个不同场合最初均被误诊为子宫平滑肌瘤。文献中已描述了约20例呈恶性病程的子宫平滑肌瘤母细胞瘤。该例UML是首例在孕期确诊的病例。回顾发现，4年前从子宫切除的肿瘤组织已显示出UML的组织学特征。这个体积大且有转移的肿瘤表现出核异型性、中度有丝分裂指数和肿瘤细胞坏死，提示为恶性肿瘤。治疗包括子宫切除术、双侧输卵管卵巢切除术以及切除大多数其他肿瘤肿块。在文献中，放疗和化疗对这些肿瘤尚未证明有效。激素疗法仅用于2例患者。在该患者中，激素对肿瘤生长的影响可能很大。肿瘤孕激素和雌激素受体呈阳性，且在孕期迅速增大。由于对这些肿瘤了解甚少，有必要进一步研究以评估激素作为致病因素和治疗可能性的影响。
