Serrano Cesar, Nucci Marisa R, Tirumani Sree H, Raut Chandrajit P, George Suzanne
Pathology Department, Brigham and Women's Hospital, Boston, Massachusetts, USA.
BMJ Case Rep. 2014 Mar 27;2014:bcr2013202107. doi: 10.1136/bcr-2013-202107.
Uterine leiomyosarcoma (ULMS) usually follows an aggressive clinical course, although a small proportion of ULMS exhibit a more indolent course, which in turn reflects heterogeneity within this disease and the need to identify and characterise this distinct subgroup. The role of hormone therapy in ULMS is yet to be elucidated. We report a patient with well-differentiated metastatic ULMS on hormone replacement therapy (HRT) at the time of the diagnosis. The withdrawal of the HRT led to a significant decrease in the tumour burden and symptomatic improvement. The patient further benefited from aromatase inhibitor treatment once the benefit from the HRT withdrawal reached a plateau. The present case report describes for the first time hormone-dependency for tumour growth in a ULMS. We propose that a subset of ULMS that follow a protracted/indolent course might depend on hormone stimulation for tumour proliferation, and antihormone treatment can therefore be useful in these patients.
子宫平滑肌肉瘤（ULMS）通常呈现侵袭性临床病程，尽管一小部分ULMS表现出较为惰性的病程，这反过来反映了该疾病的异质性，以及识别和表征这一独特亚组的必要性。激素疗法在ULMS中的作用尚待阐明。我们报告一例患者，诊断时处于激素替代疗法（HRT）下，患有高分化转移性ULMS。停用HRT导致肿瘤负荷显著降低且症状改善。一旦停用HRT的获益达到平台期，患者进一步从芳香化酶抑制剂治疗中获益。本病例报告首次描述了ULMS中肿瘤生长的激素依赖性。我们提出，一部分病程迁延/惰性的ULMS可能依赖激素刺激来促进肿瘤增殖，因此抗激素治疗可能对这些患者有用。
