Piątek Szymon, Szymusik Iwona, Dańska-Bidzińska Anna, Ołtarzewski Mariusz, Trojan Gabriela, Bidziński Mariusz
Department of Gynecologic Oncology, the Maria Sklodowska-Curie National Research Institute of Oncology, 5 Roentgen Street, 02-781 Warsaw, Poland.
1st Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-015 Warsaw, Poland.
J Clin Med. 2022 Aug 15;11(16):4761. doi: 10.3390/jcm11164761.
Uterine sarcomas occur very rarely in young women. Hysterectomy, which is a standard treatment, may not be acceptable for those patients, especially nulliparous women. Fertility-sparing management may be an alternative. The aim of the study was to assess fertility-sparing management in patients with uterine sarcoma. Eleven patients were eligible for the study. Histopathologic types of the tumor included: adenosarcoma (n = 3), low-grade endometrial stromal sarcoma ( = 3), low-grade myofibroblastic sarcoma ( = 1), leiomyosarcoma ( = 1), leiomyosarcoma myxoides ( = 1), rhabdomyosarcoma ( = 1), high grade endometrial stromal sarcoma ( = 1). The mean age of the patients at the time of diagnosis was 27.4 years (range: 17-35) and the average follow-up 61 months (range: 12-158). Six patients received adjuvant treatment: megestrol ( = 5) and chemotherapy ( = 1). Recurrence was diagnosed in five cases. Median time to recurrence was 35 months (range: 8-90). Three patients conceived spontaneously following treatment and gave at least one live birth. In total, five full-term pregnancies were recorded and five healthy children were born. Fertility-sparing management may be considered in some patients with uterine sarcoma; however, it may not be appropriate in high-grade endometrial stromal sarcoma. Patients with adenosarcoma may have a low chance of childbearing.
子宫肉瘤在年轻女性中极为罕见。子宫切除术作为一种标准治疗方法，对于这些患者，尤其是未生育过的女性来说，可能并不被接受。保留生育功能的治疗方案或许是一种选择。本研究的目的是评估子宫肉瘤患者保留生育功能的治疗情况。11名患者符合研究条件。肿瘤的组织病理学类型包括：腺肉瘤（n = 3）、低级别子宫内膜间质肉瘤（ = 3）、低级别肌成纤维细胞肉瘤（ = 1）、平滑肌肉瘤（ = 1）、黏液样平滑肌肉瘤（ = 1）、横纹肌肉瘤（ = 1）、高级别子宫内膜间质肉瘤（ = 1）。患者诊断时的平均年龄为27.4岁（范围：17 - 35岁），平均随访时间为61个月（范围：12 - 158个月）。6名患者接受了辅助治疗：甲地孕酮（ = 5）和化疗（ = 1）。5例被诊断为复发。复发的中位时间为35个月（范围：8 - 90个月）。3名患者在治疗后自然受孕并至少生育了一个活产婴儿。总共记录了5次足月妊娠，5名健康婴儿出生。对于一些子宫肉瘤患者可以考虑保留生育功能的治疗；然而，这在高级别子宫内膜间质肉瘤中可能并不适宜。腺肉瘤患者的生育几率可能较低。
