探讨临床病理特征,诊断,与卵巢性索肿瘤(UTROSCT)相似的子宫肿瘤的手术治疗和预后。临床数据,手术方法,组织病理学,对7例UTROSCTs的免疫组织化学特征进行回顾性分析和随访。4例患者均为绝经前妇女。最常见的临床表现是月经过多(n=4),其次是绝经后下腹部肿块(n=2)和绝经后出血(n=1)。妇科超声提示子宫肌瘤4例,子宫腺肌病合并子宫肌瘤2例,子宫内包块1例。仅2例术前进行盆腔MRI检查,两者都表明子宫肌瘤变性,包括1例疑似恶性肿瘤患者。6例患者术前血清肿瘤标志物测定,只有1名患者CA125水平升高,高达158U/mL。双侧附件切除术或输卵管切除术是最常见的治疗方式(n=6)。肿瘤位于子宫肌层内(n=4),粘膜下层(n=1),和峡部到外宫颈口(n=1),范围为2至12(平均值=8)cm。2例出现水肿和变性,坏死1例。术后随访31~82个月,平均43个月。不幸的是,1例患者在随访54个月时死亡,未进行子宫切除术。其余6例患者术后均无肿瘤复发或转移。组织学检查显示肿瘤由排列在绳索中的上皮样肿瘤样细胞组成,小梁,和巢。7例肿瘤均表达2种性索分化标志物。此外,所有肿瘤都表达平滑肌标记,而上皮标志物CK(4/7)。子宫内膜基质标志物CD10(0/7)。发现Ki-67增殖指数<5%(5/7)。对于没有任何生育要求的妇女,可以考虑选择全子宫切除术。然而,对于希望保持生殖能力的年轻女性来说,保留子宫的手术可能是一种选择,尽管它需要仔细的术后监测。在后续监测方面,MRI比超声更适合。UTROSCT的诊断很大程度上依赖于组织病理学检查和免疫组织化学分析。
To investigate the clinicopathological features, diagnosis, surgical treatment and prognosis of uterine tumors similar to ovarian sex cord tumors (UTROSCT). The clinical data, surgical approach, histopathological, and immunohistochemical features of 7 cases of UTROSCTs were retrospectively reviewed and followed up. All 4 patients were premenopausal women. The most common clinical presentation was menorrhagia (n = 4) followed by postmenopausal lower abdominal mass (n = 2) and postmenopausal bleeding (n = 1). Gynecological ultrasonography suggested uterine fibroids in 4 cases, adenomyosis with uterine fibroids in 2 cases, and an intrauterine mass in 1 case. Pelvic MRI was performed preoperatively in only 2 cases, and both indicated uterine fibroid degeneration, including 1 patient with suspected malignancy. Preoperative serum tumor markers were measured in 6 patients, and only 1 patient had elevated CA125 levels, up to 158 U/mL. Total hysterectomy with bilateral adnexectomy or salpingectomy was the most common treatment pattern (n = 6). The tumors were located within the myometrium (n = 4), submucosa (n = 1), and isthmus to external cervical os (n = 1), with a range of 2 to 12 (mean = 8) cm. Edema and degeneration were observed in 2 cases, and necrosis in 1 case. Postoperative follow-up ranged from 31 to 82 (mean = 43) months. Unfortunately, 1 patient died at 54 months of follow-up without undergoing hysterectomy. The remaining 6 cases showed no tumor recurrence or metastasis after surgery. Histological examination revealed a tumor composed of epithelioid tumor-like cells arranged in cords, trabeculae, and nests. All 7 tumors showed expression of 2 sex cord differentiation markers. Furthermore, all tumors expressed the smooth muscle marker, while epithelial marker CK (4/7). endometrial stromal marker CD10(0/7). The Ki-67 proliferation index was found to be <5% (5/7). The option of total hysterectomy may be considered for women who do not have any fertility requirements. However, for young women who desire to maintain their reproductive capacity, surgery to preserve the uterus may be an alternative, although it necessitates careful postoperative monitoring. In terms of follow-up monitoring, MRI is more suitable than ultrasound. The diagnosis of UTROSCT heavily relies on histopathological examination and immunohistochemical analysis.