Kadhel P, Smail M, Borja De Mozota D
Service de gynécologie et obstétrique, pôle parent-enfant, centre hospitalier universitaire de Pointe-à-Pitre/Abymes, route de Chauvel, 97159 Pointe-à-Pitre, Guadeloupe; Institut national de la santé et de la recherche médicale Inserm U1085-IRSET, campus universitaire de Fouillole, 97157 Pointe-à-Pitre, Guadeloupe.
Service de gynécologie et obstétrique, pôle parent-enfant, centre hospitalier universitaire de Pointe-à-Pitre/Abymes, route de Chauvel, 97159 Pointe-à-Pitre, Guadeloupe.
J Gynecol Obstet Hum Reprod. 2017 Sep;46(7):609-611. doi: 10.1016/j.jogoh.2017.06.002. Epub 2017 Jun 21.
The unexpected diagnosis of a leiomyosarcoma from a surgical specimen of a presumed leiomyoma is rare, but with deleterious consequences, especially if morcellation techniques are used. There are currently no effective methods for such a preoperative diagnosis. Ulipristal acetate has demonstrated efficacy for the preoperative treatment of leiomyomas, but not for all patients. We report two cases of leiomyosarcomas in patients treated with ulipristal acetate for a presumed leiomyoma. We propose that ineffective ulipristal acetate treatment may indicate a population in which uterine leiomyosarcoma is more prevalent. Attention should be given to any features of clinical and imaging examinations which raise the suspicion of a leiomyosarcomas in this population. Such suspicion should guide appropriate measures to avoid seeding the tumor, postponing the diagnosis, upstaging the patient and delaying the treatment (SPUD).
从疑似平滑肌瘤的手术标本中意外诊断出平滑肌肉瘤的情况罕见，但后果严重，尤其是在使用粉碎技术时。目前尚无有效的术前诊断方法。醋酸乌利司他已证明对平滑肌瘤的术前治疗有效，但并非对所有患者都有效。我们报告了两例接受醋酸乌利司他治疗疑似平滑肌瘤的患者发生平滑肌肉瘤的病例。我们提出，醋酸乌利司他治疗无效可能表明子宫平滑肌肉瘤更为普遍的人群。对于该人群中任何引起平滑肌肉瘤怀疑的临床和影像学检查特征都应予以关注。这种怀疑应指导采取适当措施以避免肿瘤播散、延迟诊断、使患者分期提高和延误治疗（SPUD）。
