Dudzik Kamila, Krzysteczko Agnieszka, Kolny Leon, Bąk Agnieszka, Stawicka-Ociepka Ewelina, Nowosielski Krzysztof
Department of Gynecology, Obstetrics and Oncological Gynecology, Provincial Specialist Hospital, Tychy, Poland.
Department of Gynecology and Obstetrics, Silesia Institute of Mother and Newborn, Chorzow, Poland.
Prz Menopauzalny. 2017 Mar;16(1):23-25. doi: 10.5114/pm.2017.67367. Epub 2017 Apr 26.
Synchronous gynecological cancers are rarely described. Those cases account for approximately up to 6% of female genital tract malignancies. The presence of synchronous endometrial adenocarcinoma and gynecological tract neoplasia is rare - the most commonly described is synchronous adenocarcinoma and endometrial ovarian cancer (accounting for 15-20% of ovarian neoplasia and 5% of endometrial cancers). Concomitant uterine carcinosarcoma and ovarian cancer, or endometrial adenocarcinoma are extremely rare. Up till now, only 3 cases of synchronous adenocarcinoma and leiomyosarcoma were described. In the present study a case of 60-year-old woman diagnosed with synchronous endometrial adenocarcinoma and leiomyosarcoma uteri is described. As the preoperative evaluation revealed endometrial adenocarcinoma G2 with intermediate-risk of lymph node metastasis and synchronous leiomyosarcoma G3, total hysterectomy with bilateral salpingo-oophorectomy and systemic lymphadenectomy was performed showing no lymphatic involvement. In the postoperative evaluation the patient was qualified to adenocarcinoma low recurrence-risk group (adenocarcinoma G1 with no LVSI, FIGO IA) - no further radiotherapy was required. However, as synchronous leiomyosarcoma G3 was diagnosed, we decided to refer the patient for adjuvant chemotherapy. Contemporary recommendation on the diagnosis and treatment of uterine carcinomas, especially uterine leiomyosarcomas, is also described in this paper. The presented case showed that diagnosis and treatment of women with uterine tumors should be individualized as in the same case an extremely rare cancer type can be present which, consequently, changes the treatment regimen and prognosis.
同步性妇科癌症鲜有报道。这些病例约占女性生殖道恶性肿瘤的6%。同步性子宫内膜腺癌与妇科肿瘤罕见——最常报道的是同步性腺癌与子宫内膜卵巢癌（占卵巢肿瘤的15 - 20%，占子宫内膜癌的5%）。子宫癌肉瘤与卵巢癌或子宫内膜腺癌同时存在极为罕见。迄今为止，仅报道了3例同步性腺癌和平滑肌肉瘤病例。本研究描述了一例60岁女性，诊断为同步性子宫内膜腺癌和子宫平滑肌肉瘤。术前评估显示为G2级子宫内膜腺癌，有淋巴结转移的中度风险，同步性G3级平滑肌肉瘤，遂行全子宫切除术加双侧输卵管卵巢切除术及系统性淋巴结清扫术，结果显示无淋巴结受累。术后评估该患者符合腺癌低复发风险组（G1级腺癌，无淋巴血管间隙浸润，国际妇产科联盟IA期）——无需进一步放疗。然而，由于诊断为同步性G3级平滑肌肉瘤，我们决定让患者接受辅助化疗。本文还描述了关于子宫癌，尤其是子宫平滑肌肉瘤诊断和治疗的当代建议。该病例表明，子宫肿瘤女性的诊断和治疗应个体化，因为在同一病例中可能存在极为罕见的癌症类型，从而改变治疗方案和预后。
