Uterine Leiomyosarcoma: A Case Report

Abstract

<p>本文報告一位41歲女性，因持續兩週的下腹悶痛及腫塊求診，術後確診為子宮平滑肌惡性肉瘤，她在兩年半前曾接受腹腔鏡子宮肌瘤切除術，診斷為非典型子宮肌瘤。子宮平滑肌惡性肉瘤的發生率極低，目前超音波及電腦斷層尚無法和子宮肌瘤明確區分，而核磁共振是一個相當敏感的工具，因此若腫瘤超過8 cm或生長快速，宜進一步以核磁共振或以組織切片或直接手術探查。此外，非典型子宮肌瘤，雖多數為良性，但有進展為惡性肉瘤的可能，建議在術後至少5年內，每半年接受骨盆腔理學檢查，每年胸部X光攝影及骨盆腔影像學檢查，以早期發現復發或惡性的腫瘤。</p> <p> </p><p>We herein reported a 41-year-old woman presenting with two weeks of lower abdominal mass and dull pain. She underwent total hysterectomy with bilateral salpingo-oophorectomy, and the pathology examination revealed uterine leiomyosarcoma. The patient had a surgical history of laparoscopic myomectomy with a pathologic diagnosis of atypical leiomyoma of the uterus two and a half years ago.</p> <p>The incidence of uterine leiomyosarcoma is very low. In the modern era, echography and computed tomography remain unable to clearly differentiate uterine leiomyosarcoma from leiomyoma, whereas MRI is a sensitive tool for diagnosis. Therefore, if a lower abdominal mass is more than 8 cm or rapidly growing, MRI, biopsy, or laparoscopic exploration, is strongly recommended. Moreover, while atypical leiomyoma of the uterus is mostly benign in nature, it has a high rate of recurrence and the potential of transformation into leiomyosarcoma. Hence, for early detection of recurrence, pelvic examination twice a year, annual chest X-ray, and pelvic imaging are recommended for at least 5 years postoperatively in these cases.</p> <p> </p>