Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Gynecol Oncol. 2011 May 1;121(2):319-22. doi: 10.1016/j.ygyno.2010.12.363. Epub 2011 Jan 26.
To determine the incidence of adnexal and lymph node (LN) metastasis in newly diagnosed endometrial stromal sarcoma (ESS).
We identified all cases with a diagnosis of ESS evaluated at our institution from January 1, 1980 to October 31, 2009. All uterine pathology was reviewed at our center. High-grade or undifferentiated tumors and ESS arising in extrauterine sites were excluded. Pertinent clinical data were abstracted from electronic medical records. Appropriate statistical tests were performed using SPSS16.0.
We identified 94 cases of ESS. LN metastasis was identified in 7 (19%) of 36 patients who underwent LN evaluation. Six of the 7 cases with LN metastasis had lymphovascular invasion (LVI). LVI status was not reported in the other case. Five of the 7 patients with LN metastasis had grossly positive LNs with or without other gross extrauterine disease. Of 20 patients with disease grossly limited to the uterus and grossly normal LNs, 2 (10%) had LN metastasis. Both of these cases had LVI and extensive myoinvasion. Eighty-seven cases (93%) underwent salpingo-oophorectomy. Adnexal metastasis was identified in 11 (13%) of 87 cases, all manifested by gross adnexal tumor and occurring in patients with other gross pelvic extrauterine disease.
The incidence of LN metastasis in ESS is commonly associated with gross extrauterine disease, extensive myoinvasion, and LVI. Since myoinvasion and LVI status often are not assessable at the time of hysterectomy, LN dissection remains a reasonable option at primary surgery. The rate of adnexal metastasis appears to be negligible in the absence of gross adnexal and extrauterine tumor.
确定新诊断的子宫内膜间质肉瘤（ESS）中附件和淋巴结（LN）转移的发生率。
我们从 1980 年 1 月 1 日至 2009 年 10 月 31 日在我院评估的所有 ESS 病例中确定了所有病例。在我们中心对所有子宫病理学进行了审查。排除高级别或未分化肿瘤和源自子宫外部位的 ESS。从电子病历中提取相关临床数据。使用 SPSS16.0 进行适当的统计检验。
我们确定了 94 例 ESS。在接受 LN 评估的 36 例患者中，有 7 例（19%）发生 LN 转移。在 7 例有 LN 转移的病例中，有 6 例有淋巴血管侵犯（LVI）。在其他病例中未报告 LVI 状态。在 7 例有 LN 转移的患者中，有 5 例有大体阳性淋巴结和/或其他大体盆腔外疾病。在 20 例疾病大体局限于子宫且大体正常淋巴结的患者中，有 2 例（10%）有 LN 转移。这两例均有 LVI 和广泛的肌内侵犯。87 例（93%）行双侧附件切除术。在 87 例病例中，有 11 例（13%）发现附件转移，均表现为大体附件肿瘤，发生于有其他大体盆腔外疾病的患者中。
LN 转移在 ESS 中常见于大体盆腔外疾病、广泛的肌内侵犯和 LVI。由于在子宫切除时通常无法评估肌内侵犯和 LVI 状态，因此在初次手术时行 LN 清扫术仍是合理的选择。在没有大体附件和子宫外肿瘤的情况下，附件转移的发生率似乎可以忽略不计。
