Iavazzo C, Kokka F, Sahdev A, Singh N, Reynolds K
Gynaecological Department, St Bartholomews Hospital, London EC1A 7BE, UK.
Case Rep Obstet Gynecol. 2013;2013:401962. doi: 10.1155/2013/401962. Epub 2013 Mar 7.
Background. Didelphys uterus is a noncommon finding in women. Till now, few cases with benign mesenchymal tumors in patients with didelphys uterus are described. We present a case of a patient with carcinosarcoma arising in a didelphys uterus. Case. A 73-year-old patient presented with profuse watery postmenopausal bleeding. On examination under anesthesia, left and right cervixes were identified. Tumor extended from the left cervix into the lower third of the vagina and was adherent to the right vaginal sidewall. There was no evidence of parametrial extension. Tissue was sent for biopsy which revealed high-grade uterine carcinosarcoma. Two uterine fundi and two vaginas in keeping with uterine didelphys were identified on imaging. The patient underwent vaginal excision of the protruding tumor measuring 8 × 6 cm with harmonic scalpel followed by total abdominal hysterectomy and bilateral salpingooophorectomy. Although a number of pelvic and paraaortic lymph nodes were also identified on imaging, she was not planned for lymphadenectomy after MDT (multidisciplinary team) discussion because of her comorbidities. The final histology confirmed the diagnosis. Conclusion. According to our knowledge, this is the second case of carcinosarcoma arising in didelphys uterus in the world literature.
背景。双子宫在女性中并不常见。迄今为止，鲜有关于双子宫患者发生良性间叶性肿瘤的病例报道。我们报告一例双子宫发生癌肉瘤的患者。病例。一名73岁患者出现绝经后大量水样阴道流血。在麻醉下检查时，发现左右宫颈。肿瘤从左宫颈延伸至阴道下三分之一，并附着于右侧阴道侧壁。无宫旁组织受累证据。组织送检活检，结果显示为高级别子宫癌肉瘤。影像学检查发现两个子宫底和两个阴道，符合双子宫表现。患者接受了用超声刀切除突出的8×6 cm肿瘤的阴道切除术，随后进行了全腹子宫切除术和双侧输卵管卵巢切除术。尽管影像学检查还发现了多个盆腔和腹主动脉旁淋巴结，但由于其合并症，多学科团队讨论后未计划对其进行淋巴结清扫术。最终组织学检查确诊。结论。据我们所知，这是世界文献中第二例双子宫发生癌肉瘤的病例。
