Montik Nina, Grelloni Camilla, Filosa Alessandra, Goteri Gaia, Di Giuseppe Jacopo, Natalini Leonardo, Ciavattini Andrea
Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60123 Ancona, Italy.
Anatomic Pathology, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60126 Ancona, Italy.
Diagnostics (Basel). 2024 Jul 6;14(13):1438. doi: 10.3390/diagnostics14131438.
A 43-year-old patient with a history of uterine fibromatosis was referred to our hospital for menometrorrhagia and pelvic pain. At the pelvic ultrasound, a highly-vascularized myometrial lesion in volumetric increase was described. An elongated, solid, hypoechoic, painless, and highly vascularized left parauterine mass was identified. On histological examination, a uterine smooth muscle tumor of uncertain malignant potential (STUMP) with intravascular invasion of the left uterine vein was diagnosed. The adnexa and peritoneum were free of disease. On a retrospective evaluation of the ultrasound images, we noticed that the intravascular lesion showed sonographic features comparable to the original mass. Moreover, the Color Doppler (CD) analysis revealed an interrupted blood flow within the left uterine vein. In this case, the ultrasound proved to be an accurate diagnostic tool. When inhomogeneous uterine masses are suspected, and a parauterine/paraadnexal mass surrounded by irregular vessels are identified, the sonographer should take into account a risk of intravascular invasion. The patency of uterine and ovarian vessels should be accurately evaluated, to guide a tailored patient surgical approach.
一名有子宫纤维瘤病史的43岁患者因月经过多和盆腔疼痛转诊至我院。盆腔超声检查显示，子宫肌层有一个高度血管化且体积增大的病变。发现一个细长的、实性的、低回声的、无痛的且高度血管化的左侧子宫旁肿块。组织学检查诊断为具有不确定恶性潜能的子宫平滑肌瘤（STUMP），伴有左侧子宫静脉的血管内侵犯。附件和腹膜无病变。在对超声图像进行回顾性评估时，我们注意到血管内病变的超声特征与原始肿块相似。此外，彩色多普勒（CD）分析显示左侧子宫静脉内血流中断。在这种情况下，超声被证明是一种准确的诊断工具。当怀疑子宫肿块不均匀，且发现子宫旁/附件旁肿块被不规则血管包围时，超声检查者应考虑血管内侵犯的风险。应准确评估子宫和卵巢血管的通畅情况，以指导为患者量身定制的手术方法。
