Mettler Liselotte, Abdusattarova Khulkar, Alkatout Ibrahim
Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Kiel, Germany -
Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Kiel, Germany.
Minerva Ginecol. 2017 Dec;69(6):517-525. doi: 10.23736/S0026-4784.17.04104-1. Epub 2017 Jul 10.
The aim of this study was to 1) estimate the incidence of unsuspected uterine sarcoma in patients after myomectomies and hysterectomies for benign uterine fibroids; 2) to assess the incidence of uterine sarcomas among patient who had uterine fibroids or a suspicion of uterine sarcoma before undergoing the surgical procedures.
Retrospective study in single center university hospital. Patient's records with uterine fibroids and uterine sarcoma from 2003 to 2015 collected. Data presented as mean and standard deviation for continuous variable and percentage for categorical variables. The exact Clopper-Pearson interval was used to calculate 95% confidence interval.
The total number of women with uterine fibroids was 2269 and uterine sarcomas 7. Of these seven, four were uterine leiomyosarcomas (ULMS), one endometrial sarcoma (ESS), one high-grade undifferentiated uterine sarcoma (HGUS) and one embryonal rhabdomyosarcoma (ERMS). Six of these patients underwent direct open conventional cancer treatment. The mean age of the patients with ULMS was 73.7±3.9 years. Immunohistochemistry results indicated SMA(+), CD 10(+), desmin(+) and h-caldesmon(+). The two patients with HGUS and ERMS were also preoperatively diagnosed with suspected malignancy and operated upon according. However, only one woman 48 years old primarily diagnosed with benign uterine fibroids underwent a laparoscopic subtotal hysterectomy (LSH) procedure; however, the histological results detected an ESS. Immunohistochemistry showed CD10(+), desmin(+), smooth muscle actin (SMA)(-), Aktin(-) and 5% Ki67(+).Two weeks after the initial surgery, an open cervical stump resection with bilateral sapping-oophorectomy and an omentectomy was performed.
The frequency of unsuspected ESS was 1/2269 among the women who underwent myomectomies and hysterectomies for the treatment of benign uterine fibroids. The total incidence of uterine sarcoma was 7/2275 among the patients who had presumed uterine fibroids or a suspicion of uterine sarcoma prior to undergoing the surgical procedures.
本研究的目的是：1）估计因良性子宫肌瘤行肌瘤切除术和子宫切除术后患者中意外子宫肉瘤的发生率；2）评估在手术前患有子宫肌瘤或疑似子宫肉瘤的患者中子宫肉瘤的发生率。
在单中心大学医院进行回顾性研究。收集2003年至2015年患有子宫肌瘤和子宫肉瘤患者的记录。连续变量数据以均值和标准差表示，分类变量数据以百分比表示。采用确切的Clopper-Pearson区间计算95%置信区间。
患有子宫肌瘤的女性总数为2269例，子宫肉瘤患者7例。在这7例中，4例为子宫平滑肌肉瘤（ULMS），1例为子宫内膜肉瘤（ESS），1例为高级别未分化子宫肉瘤（HGUS），1例为胚胎性横纹肌肉瘤（ERMS）。其中6例患者接受了直接的开放性常规癌症治疗。ULMS患者的平均年龄为73.7±3.9岁。免疫组化结果显示SMA（+）、CD 10（+）、结蛋白（+）和h-钙调蛋白（+）。2例HGUS和ERMS患者术前也被诊断为疑似恶性肿瘤并相应进行了手术。然而，只有1例48岁最初诊断为良性子宫肌瘤的女性接受了腹腔镜次全子宫切除术（LSH）；但组织学结果检测到为ESS。免疫组化显示CD10（+）、结蛋白（+）、平滑肌肌动蛋白（SMA）（-）、肌动蛋白（-）和5% Ki67（+）。初次手术后两周，进行了开放性宫颈残端切除术、双侧输卵管卵巢切除术和大网膜切除术。
在因治疗良性子宫肌瘤而行肌瘤切除术和子宫切除术后的女性中，意外ESS的发生率为1/2269。在手术前疑似患有子宫肌瘤或疑似子宫肉瘤的患者中，子宫肉瘤的总发生率为7/2275。
