Yang Jingjun, Lu Jianming
Department of General Surgery, Haining People's Hospital, Haining, Jiaxing, Zhejiang, China.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.25-0157. Epub 2025 Aug 14.
For this case, when the preoperative diagnosis indicated malignant tumor with metastasis, intraoperative frozen section examination was performed to adjust the surgical plan accordingly. This approach helped avoid overtreatment, minimizing the patient's pain and surgical trauma. This case holds educational significance.
A 45-year-old female patient underwent open myomectomy 12 years ago for uterine fibroids and laparoscopic subtotal hysterectomy 10 years ago for the same condition. During this check-up, her CA125 was found to be elevated. Further examinations, including ultrasound, enhanced CT, and enhanced MRI, all suggested a pelvic malignant tumor with liver metastasis. The patient underwent tumor resection, and both intraoperative frozen section and routine histopathologic examination confirmed that the pelvic and subphrenic tumors (which had been considered as liver metastases preoperatively) were both conventional leiomyomas.
This case highlights that leiomyomas, when metastatic, are easily misdiagnosed as malignant tumors with metastasis, presenting a significant challenge for preoperative diagnosis. Clinicians should maintain a high level of suspicion in such cases to avoid overtreatment. In this case, the intraoperative frozen section played a crucial role in preventing unnecessary pelvic lymph node dissection.
对于该病例，当术前诊断提示为伴有转移的恶性肿瘤时，进行了术中冰冻切片检查，以便相应地调整手术方案。这种方法有助于避免过度治疗，将患者的疼痛和手术创伤降至最低。该病例具有教育意义。
一名45岁女性患者12年前因子宫肌瘤接受了开腹子宫肌瘤切除术，10年前因同样病情接受了腹腔镜次全子宫切除术。在此次检查中，发现她的CA125升高。进一步检查，包括超声、增强CT和增强MRI，均提示盆腔恶性肿瘤伴肝转移。患者接受了肿瘤切除术，术中冰冻切片和常规组织病理学检查均证实盆腔和膈下肿瘤（术前被认为是肝转移瘤）均为普通平滑肌瘤。
该病例突出表明，平滑肌瘤发生转移时，很容易被误诊为伴有转移的恶性肿瘤，给术前诊断带来重大挑战。临床医生在这类病例中应保持高度怀疑，以避免过度治疗。在本病例中，术中冰冻切片在防止不必要的盆腔淋巴结清扫方面发挥了关键作用。
