Seki K, Hoshihara T, Nagata I
Department of Obstetrics and Gynecology, National Defense Medical College, Saitama, Japan.
Gynecol Obstet Invest. 1992;33(2):114-8. doi: 10.1159/000294861.
Between January 1, 1979, and September 30, 1990, a total of 1,886 patients in the National Defense Medical College Hospital, a self-referred population, had a hysterectomy because of signs and symptoms presumably resulting from uterine myomas. After hysterectomy with presumed benign disease, a histologic diagnosis of leiomyosarcoma was made in 7 patients (0.37%). Preoperative diagnosis of leiomyosarcoma was not made in any of the 7 patients. However, serum lactate dehydrogenase levels were abnormally elevated in 3 of them, and degenerative changes were found within the tumor by ultrasonography in 5 of them. Furthermore, increased lactate dehydrogenase levels and degenerative changes within the tumor were found in 3 of the patients whose tumors had 10 or more mitoses per 10 high-power fields. The prognosis for the leiomyosarcomas with increased mitotic rates is very poor. Therefore, a degenerative change within the uterine mass and an increased lactate dehydrogenase level, when present, should suggest the diagnosis of leiomyosarcoma.
1979年1月1日至1990年9月30日期间，在国防医科大学医院，共有1886名因疑似子宫肌瘤所致体征和症状而自行前来就诊的患者接受了子宫切除术。在假定为良性疾病而进行子宫切除术后，7名患者（0.37%）的组织学诊断为平滑肌肉瘤。这7名患者术前均未诊断出平滑肌肉瘤。然而，其中3名患者血清乳酸脱氢酶水平异常升高，5名患者经超声检查发现肿瘤内有退行性改变。此外，在每10个高倍视野中有10个或更多有丝分裂的肿瘤患者中，有3名患者肿瘤内乳酸脱氢酶水平升高且有退行性改变。有丝分裂率增加的平滑肌肉瘤预后非常差。因此，子宫肿块内的退行性改变和乳酸脱氢酶水平升高（如果存在）应提示平滑肌肉瘤的诊断。
