PDF(Pubmed)
Abstract：
The benign tumor uterine leiomyoma (UL) develops from the smooth muscle tissue that constitutes the uterus, whereas malignant tumor uterine sarcoma develops from either the smooth muscle tissue or stroma and is different from UL and endometrial cancer. Uterine sarcoma is broadly classified into three types: uterine leiomyosarcoma, endometrial stromal sarcoma (ESS), and carcinosarcoma. Although uterine leiomyosarcoma and ESS are both classified as uterine sarcoma, they significantly differ in terms of their sites of occurrence, symptoms, and treatment methods. Uterine leiomyosarcoma develops from the muscle tissue constituting the wall of the uterus and accounts for approximately 70% of all uterine sarcoma cases. In contrast, ESS develops from the stromal tissue beneath the endometrium and accounts for approximately 25% of all uterine sarcoma cases. ESS is classified as either low grade (LG) or high grade (HG). This case report aimed to highlight the importance of histopathologic examinations based on surgical specimens. Herein, we reported the case of a 45-year-old woman suspected of having submucosal leiomyoma of the uterus based on imaging results. Transvaginal ultrasonography and endometrial biopsy or partial dilation and curettage were performed. Contrast-enhanced magnetic resonance imaging (MRI) revealed a 32-mm mass projecting from the posterior wall of the uterus into the uterine cavity. T2-weighted imaging revealed a low signal within the mass; thus, submucosal UL was suspected. Histopathologic examination of surgical specimens obtained from a patient suspected of having submucosal UL after contrast-enhanced MRI indicated that the patient had ESS. Despite the remarkable advancements in medical imaging technology, the accuracy of contrast-enhanced MRI for detecting uterine mesenchymal tumors is limited. Therefore, histopathologic diagnosis based on surgical specimens should be performed when medical grounds for diagnosing a benign tumor on contrast-enhanced MRI are lacking.
摘要：
良性肿瘤子宫平滑肌瘤（UL）从构成子宫的平滑肌组织发展而来，而恶性肿瘤子宫肉瘤由平滑肌组织或间质发展，与UL和子宫内膜癌不同。子宫肉瘤大致分为三种类型：子宫平滑肌肉瘤，子宫内膜间质肉瘤(ESS),和癌肉瘤.尽管子宫平滑肌肉瘤和ESS都被归类为子宫肉瘤，它们的发生地点有很大不同，症状,和治疗方法。子宫平滑肌肉瘤由构成子宫壁的肌肉组织发展而来，约占所有子宫肉瘤病例的70％。相比之下,ESS从子宫内膜下的基质组织发展，约占所有子宫肉瘤病例的25％。ESS分为低等级（LG）或高等级（HG）。此病例报告旨在强调基于手术标本的组织病理学检查的重要性。在这里，我们报道了一例45岁女性,根据影像学检查结果怀疑患有子宫粘膜下平滑肌瘤.经阴道超声和子宫内膜活检或部分扩张和刮宫。对比增强的磁共振成像（MRI）显示，一个32毫米的肿块从子宫后壁突出到子宫腔中。T2加权成像显示肿块内信号较低；因此，怀疑粘膜下UL。对比增强MRI后，从怀疑患有粘膜下UL的患者获得的手术标本的组织病理学检查表明该患者患有ESS。尽管医学成像技术取得了显著进步，对比增强MRI检测子宫间充质肿瘤的准确性有限.因此,当缺乏在对比增强MRI上诊断良性肿瘤的医学依据时，应根据手术标本进行组织病理学诊断。
