Davis Amenda Ann
Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, IND.
Cureus. 2020 Jan 27;12(1):e6783. doi: 10.7759/cureus.6783.
Uterine sarcomas are a rare malignancy, often retrospectively diagnosed after myomectomy or hysterectomy. Undifferentiated uterine sarcomas (UUS) are a particularly aggressive variant of this condition. Little evidence exists regarding the postoperative management of undifferentiated sarcomas diagnosed after hysterectomy performed for presumed benign conditions. We describe the case of a 33-year-old woman who presented with heavy bleeding and subsequently underwent hysterectomy on an emergency basis after failed medical management. Cut-section of the uterus revealed a grossly benign-looking sub-mucosal fibroid. However, the final histopathology report revealed undifferentiated uterine sarcoma. We worked up the patient postoperatively with MRI to rule out metastasis and performed bilateral salpingo-oophorectomy based on hormone receptivity status. We followed this with single-agent chemotherapy with adriamycin, which was followed by continuous therapy with oral letrozole (aromatase inhibitor). The patient was found doing well at the two-year follow-up, with no evidence of relapse. Postoperative diagnosis of UUS should include imaging to rule out metastasis, consideration for completion of surgery based on hormone receptivity of tumour, and lymphadenectomy based on the subtype of tumour.
子宫肉瘤是一种罕见的恶性肿瘤，通常在肌瘤切除术或子宫切除术后通过回顾性诊断得出。未分化子宫肉瘤（UUS）是这种疾病中一种特别侵袭性的变体。对于因假定为良性疾病而进行子宫切除术后诊断出的未分化肉瘤的术后管理，几乎没有相关证据。我们描述了一名33岁女性的病例，该女性出现大量出血，在药物治疗失败后紧急接受了子宫切除术。子宫的切面显示出一个外观上看似良性的黏膜下肌瘤。然而，最终的组织病理学报告显示为未分化子宫肉瘤。我们在患者术后进行了MRI检查以排除转移，并根据激素受体状态进行了双侧输卵管卵巢切除术。随后我们使用阿霉素进行单药化疗，接着使用口服来曲唑（芳香化酶抑制剂）进行持续治疗。在两年的随访中发现患者情况良好，没有复发迹象。UUS的术后诊断应包括排除转移的影像学检查、根据肿瘤的激素受体情况考虑完成手术以及根据肿瘤亚型进行淋巴结切除术。
