Sieunarine K, Cowie A S, Bartlett J D, Lindsay I, Smith J R
Department of Gynaecology, Chelsea and Westminster Hospital at Imperial College School of Medicine (ICSM), London, United Kingdom.
Int J Gynecol Cancer. 2005 Jul-Aug;15(4):671-5. doi: 10.1111/j.1525-1438.2005.00123.x.
Adenomatoid tumors of the uterus are uncommon benign lesions derived from mesothelium, with a prevalence of 1.2% in one study of 1 000 unselected hysterectomy specimens. They are usually small and near the serosal surface; however, they may be large and diffuse (giant adenomatoid tumors). They coexist with leiomyomas in 60% of cases. A 33-year-old nulliparous woman was referred for severe menorrhagia and dysmenorrhea, thought to be due to a submucosal fibroid on ultrasound. This transpired to be an adenomatoid tumor, and she underwent three transcervical resections of the tumor (TCRT) over a period of 12 months for tumor recurrence and failure of symptom resolution. The last TCRT was performed with ultrasound guidance and laparoscopic visualization of the uterus to the resection point of blanching of the serosal surface. She failed to respond to a GnRH analogue throughout. A specialist opinion on the suitability of vascular embolization of the tumor judged that it would be ineffective for this lesion. She then underwent a Strassman procedure and removal of the adenomatoid tumor. This involved dissection of ureters and pelvic vasculature, selective temporary ligation of uterine arteries, hemisection of the uterus, and excision of the tumor with frozen sections to ensure clear tumor margins and resuturing of the uterine halves. Temporary vascular occlusion of the uterine arteries and ovarian vessels allowed a Strassman procedure, which resulted in successful resection of a recurrent giant adenomatoid tumor of the uterus, with fertility preservation in a young nulliparous woman. Two and a half years on there is no evidence of tumor recurrence.
子宫腺瘤样瘤是一种罕见的源自间皮的良性病变，在一项对1000例未经选择的子宫切除标本的研究中，其患病率为1.2%。它们通常较小，靠近浆膜表面；然而，也可能很大且呈弥漫性（巨大腺瘤样瘤）。在60%的病例中，它们与平滑肌瘤共存。一名33岁未生育的女性因严重月经过多和痛经前来就诊，超声检查认为是由黏膜下肌瘤引起。结果发现是腺瘤样瘤，在12个月的时间里，她因肿瘤复发和症状未缓解接受了三次经宫颈肿瘤切除术（TCRT）。最后一次TCRT是在超声引导下并通过腹腔镜观察子宫至浆膜表面变白的切除点进行的。她对促性腺激素释放激素类似物始终没有反应。关于肿瘤血管栓塞适用性的专家意见认为，这种方法对该病变无效。然后她接受了斯特拉斯曼手术并切除了腺瘤样瘤。这包括解剖输尿管和盆腔血管、选择性暂时结扎子宫动脉、子宫半切、用冰冻切片切除肿瘤以确保肿瘤边缘清晰以及将子宫两半重新缝合。子宫动脉和卵巢血管的暂时血管闭塞使得能够进行斯特拉斯曼手术，成功切除了一例复发的子宫巨大腺瘤样瘤，同时保留了一名年轻未生育女性的生育能力。两年半过去了，没有肿瘤复发的迹象。
