Hassini A, Khemiri B, Sfar E, Chelly D, Chennoufi M B, Chelly H
Service A de Gynécologie Obstétrique, Centre de Maternité et de Néonatologie de Tunis, Tunisie.
J Gynecol Obstet Biol Reprod (Paris). 2006 Jun;35(4):348-55. doi: 10.1016/s0368-2315(06)76407-9.
Uterine sarcomas are rare tumours characterized by clinical and histopathological diversity and poor prognosis. We analyzed diagnostic, prognostic and therapeutic difficulties encountered with these tumors by insisting on the importance of early diagnosis.
From 1997 to 2004 ten patients with uterine sarcoma who underwent surgery in the obstetrics and gynecology unit at the Tunis maternity center were included in this retrospective study. The tumors were classified at the time of diagnosis using the FIGO staging system. The histological diagnosis was based on the WHO classification.
There were 5 cases of leiomyosarcoma, 2 cases of carcinosarcoma, 2 cases of endometrial stromal sarcoma and 1 adenosarcoma. There were four cases of stage I, two cases of stage II, two cases of stage III and two of stage IV tumors. The diagnosis of uterine sarcoma was strongly suspected and proved before the initial operation in 20% of cases and during this operation in 60% of cases. Diagnosis was only established at the histological exam in two cases. Total hysterectomy with bilateral salpingo-oophorectomy was performed in 90% of patients. Radiation therapy was performed in four. Chemotherapy was delivered in two patients. After an average of four years five patients were in remission, three had died and two were lost to follow-up.
Early preoperative or intra-operative diagnosis is essential while awaiting for more effective chemotherapy protocols or therapeutic strategies.
子宫肉瘤是罕见肿瘤，具有临床和组织病理学多样性且预后较差。我们通过强调早期诊断的重要性，分析了这些肿瘤在诊断、预后和治疗方面遇到的困难。
1997年至2004年期间，突尼斯妇产中心妇产科收治的10例接受手术的子宫肉瘤患者纳入本回顾性研究。诊断时使用国际妇产科联盟（FIGO）分期系统对肿瘤进行分期。组织学诊断依据世界卫生组织（WHO）分类。
平滑肌肉瘤5例，癌肉瘤2例，子宫内膜间质肉瘤2例，腺肉瘤1例。Ⅰ期肿瘤4例，Ⅱ期2例，Ⅲ期2例，Ⅳ期2例。20%的病例在初次手术前强烈怀疑并确诊为子宫肉瘤，60%的病例在手术期间确诊。仅2例在组织学检查时确诊。90%的患者接受了全子宫切除术加双侧输卵管卵巢切除术。4例接受了放射治疗。2例患者接受了化疗。平均4年后，5例患者缓解，3例死亡，2例失访。
在等待更有效的化疗方案或治疗策略的同时，早期术前或术中诊断至关重要。
