Abdul Ghaffar Nor Aliza, Ismail M Pazudin, Nik Mahmood N M Zaki, Daud Khurshiah, Abu Dzarr G A
Department of Obstetrics and Gynaecology, Universiti Sains Malaysia, Kelantan, Malaysia.
Maturitas. 2008 Jun 20;60(2):177-9. doi: 10.1016/j.maturitas.2008.03.013. Epub 2008 May 14.
Uterine fibroid or leiomyoma is the commonest benign uterine tumour. Its occurrence in the postmenopausal age group is rare and if enlargement of the fibroid noted during this time, the diagnosis of leiomyosarcoma is provisional until proven otherwise. A case of a postmenopausal woman with a huge uterine fibroid associated with polycythaemia is presented whereby the mass was noted to increase in size within 2 years. The patient was otherwise well except for the growing uterine mass. She had venesection done to treat her polycythaemia and later underwent surgery for total abdominal hysterectomy and bilateral salpingoophoorectomy. The histopathology report confirmed leiomyoma of uterus with no evidence of sarcomatous changes. It was suggested that large uterine myoma may cause secondary polycythaemia by three postulated mechanisms, i.e. presence of hypoxia suggesting shunting within the tumour, second, the uterine fibroid was compressing the ureters resulting in inappropriate excessive production of erythropoietin by the kidneys, and third, the tumour itself may have been producing the erythropoietin.
子宫肌瘤或平滑肌瘤是最常见的子宫良性肿瘤。它在绝经后年龄组中很少见，如果在此期间发现肌瘤增大，在确诊为平滑肌肉瘤之前，诊断只能是临时的，除非另有证明。本文介绍了一例绝经后妇女患有巨大子宫肌瘤并伴有红细胞增多症的病例，该肿块在2年内被发现增大。除了不断增大的子宫肿块外，患者其他方面情况良好。她接受了静脉切开术以治疗红细胞增多症，后来接受了全腹子宫切除术和双侧输卵管卵巢切除术。组织病理学报告证实为子宫平滑肌瘤，无肉瘤样改变的证据。有人提出，大的子宫肌瘤可能通过三种假定机制导致继发性红细胞增多症，即肿瘤内存在提示分流的缺氧情况；第二，子宫肌瘤压迫输尿管，导致肾脏不适当过度产生促红细胞生成素；第三，肿瘤本身可能一直在产生促红细胞生成素。
