Irvin W, Pelkey T, Rice L, Andersen W
Division of Gynecologic Oncology, University of Virginia Medical Center, Charlottesville, Virginia, 22908, USA.
Gynecol Oncol. 1998 Nov;71(2):313-6. doi: 10.1006/gyno.1998.5142.
Extraovarian malignant transformation of endometriosis is a rare event; 52 cases have been reported. We describe the first published account in the world literature of an endometrial stromal sarcoma (ESS) arising in the vulva from a focus of endometriosis.
A 34-year-old G4 P3 morbidly obese white female was seen with a 1-year history of a palpable lesion arising within the superior aspect of the left labium majus. Radical left hemivulvectomy with clitorectomy was performed. The histopathologic findings were consistent with ESS arising from endometriosis associated with the extrapelvic portion of the round ligament within the canal of Nuck. Twenty months later metatastatic ESS developed in the upper lobe of the right lung and the patient underwent wedge resection. Nine months later she developed a recurrent pulmonary nodule at the site of the previous wedge resection and underwent successful right pulmonary lobectomy. The patient was last seen in October 1995 and had no evidence of disease at that time.
Since approximately 0.7-1.0% of patients with endometriosis have lesions that will ultimately undergo malignant transformation, consideration should be given to bilateral oophorectomy at the time of abdominal surgery in patients with significant endometriosis.
子宫内膜异位症的卵巢外恶性转化是一种罕见事件；已报道52例。我们描述了世界文献中首例源自外阴子宫内膜异位症病灶的子宫内膜间质肉瘤（ESS）。
一名34岁、孕4产3的病态肥胖白人女性，因左侧大阴唇上份出现可触及肿物1年就诊。行左侧根治性半外阴切除术及阴蒂切除术。组织病理学检查结果符合源自与Nuck管内圆韧带盆腔外部分相关的子宫内膜异位症的ESS。20个月后，右肺上叶出现转移性ESS，患者接受楔形切除术。9个月后，她在先前楔形切除部位出现复发性肺结节，并成功接受了右肺叶切除术。该患者最后一次就诊于1995年10月，当时无疾病证据。
由于约0.7%-1.0%的子宫内膜异位症患者的病灶最终会发生恶性转化，对于有严重子宫内膜异位症的患者，在腹部手术时应考虑行双侧卵巢切除术。
