Robboy S J, Bentley R C, Butnor K, Anderson M C
Department of Pathology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Environ Health Perspect. 2000 Oct;108 Suppl 5:779-84. doi: 10.1289/ehp.00108s5779.
Smooth-muscle tumors of uterine origin encompass a broad family of neoplasms. The leiomyoma, by far the most common of all the neoplasms, generally is hormone sensitive, with rates of growth semiquantitatively related to estrogen and progesterone receptor levels. Several forms of degenerative change can occur in the leiomyoma. The most common is hyaline degeneration, which is important in that it should not be mistaken for the coagulative tumor cell necrosis seen in leiomyosarcoma. Red degeneration (necrobiosis) is a form of degeneration that occurs characteristically but not exclusively in pregnancy, and the process is often the cause of pain and fever. Several forms of treatment have been used medically in the treatment of leiomyoma. Gonadotropin-releasing hormone analogs or agonists or selective arterial embolization with polyvinylformaldehyde particles may lead to substantial degeneration or infarction of the leiomyoma, respectively. Several variants of leiomyoma, the cellular and symplastic leiomyomas, are important to recognize, as they can be misinterpreted as sarcoma. In addition, there are two unusual growth patterns of leiomyoma that are important to recognize. Both the benign metastasizing leiomyoma and disseminated peritoneal leiomyomatosis are found outside the uterus, and neither is malignant. Recent studies offer insights into their origin and hormonal influences. From a diagnostic and therapeutic point of view, the leiomyosarcoma, while rare, is clinically of great import. Coagulative necrosis, cytologic atypia, and mitotic counts are all important in diagnosing the condition.
子宫源性平滑肌瘤包括一大类肿瘤。平滑肌瘤是所有肿瘤中最常见的一种，通常对激素敏感，其生长速度与雌激素和孕激素受体水平呈半定量关系。平滑肌瘤可发生几种退行性改变。最常见的是玻璃样变性，重要的是不应将其误诊为平滑肌肉瘤中所见的凝固性肿瘤细胞坏死。红色变性（坏死性变）是一种退行性改变，典型但并非仅发生于妊娠期，该过程常是疼痛和发热的原因。医学上已采用多种治疗方法来治疗平滑肌瘤。促性腺激素释放激素类似物或激动剂或用聚乙烯醇颗粒进行选择性动脉栓塞，可能分别导致平滑肌瘤发生实质性变性或梗死。平滑肌瘤的几种变异型，即细胞性和平行性平滑肌瘤，需要加以识别，因为它们可能被误诊为肉瘤。此外，有两种不寻常的平滑肌瘤生长模式也需要加以识别。良性转移性平滑肌瘤和播散性腹膜平滑肌瘤病均发生于子宫外，且均为良性。近期研究对它们的起源和激素影响提供了见解。从诊断和治疗的角度来看，平滑肌肉瘤虽然罕见，但临床上非常重要。凝固性坏死、细胞异型性和有丝分裂计数在诊断该病时均很重要。
