| Objective:Uterine adenosarcoma(UA)is a mixed tumor consisting of benign or atypical hyperplasia glandular epithelium and sarcomatous interstitium.It is rare in clinical practice and accounts for about 0.2%of uterine malignant tumors.Therefore,it is easy to miss diagnosis or misdiagnosis the early stages.it is a]ow degree of malignancy,easy to relapse.The clinical features,pathological features and follow-up results of uterine adenoma were retrospectively analyzed.TO explore the diagnosis and differential diagnosis,treatment suggestions and prognostic factors in order to raise the awareness of the disease.Methods:To collect all cases of uterine sarcoma patients admitted to Qilu Hospital of Shandong University from October 2009 to October 2017.Wherein for pathologically diagnosed as uterine adenosarcoma 15 patients clinical data were analyzed retrospectively,including age,chief complaint,brief medical history,clinical manifestations,preoperative serum.tumor markers,preoperative ultrasound,pelvic CT/MRI,surgical methods,tumor size,postoperative pathology,surgical pathological staging,postoperative adjuvant therapy,and follow-up.At the same time,we searched and reviewed related articles in the PubMed database and summarized the clinical features,pathological features,treatment methods and prognosis of the diseases.The clinical data of the patients were analyzed with GraphPad Prism 6.0 statistical software.The single factor analysis of the prognostic factors was Log-rank test.P<0.05 was considered statistically significant.Results:1.Age of onset:The age of onset of uterine adenoma in 15 patients was 19 to 68 years old,and the median age of onset was 47 years old;including 8 premenopausal patients and 7 postmenopausal patients.2.Incidence rate:A total of 188 cases of uterine sarcoma were treated in Qilu Hospital of Shandong University within 8 years,of which 15 cases were diagnosed with uterine adenoma by pathology,accounting for 7.98%of uterine sarcoma in the same period.3.Chief complaint:Irregular vaginal bleeding is the main complaint for the first visit,followed by pain in the lower abdomen and and touch the tumor comes out of the vaginal opening.4.Tumor marker examination:Preoperative serum tumor markers CA125 were elevated in 6 patients,ranging from 49.39 to 196.9 U/ml.5.Imaging examination:Preoperative pelvic ultrasound prompted uterine enlargement in 9 cases,Wherein the greatest of uterus 18× 12×11cm;The preoperative pelvic ultrasound prompted 5 cases of cervical occupation.The uterus was abnormal in shape,irregular irregular masses were seen in the intrauterine or lower uterine segment,and color Doppler detection showed different degrees of blood flow signals.4 patients underwent preoperative CT scan + enhancement,all showed an increase in uterine volume,and of which 3 cases showed significant non-uniform enhancement.3 patients underwent preoperative MRI scans and enhancements,all suggesting that the degree of uterine enlargement,uterine cavity occupancy,and some grid-like changes were observed,all of which showed mixed signals.DWI showed high signal,of which One case showed lymphadenopathy.6.Tumor staging:According to the FIGO staging(2009)criteria for surgical staging of uterine adenomas:There were 5 cervical adenomas(Including 4 cases of IB1 phase and 1 case of IVB phase)and 10 uterine adenomas(Including 2 cases of IA stage,4 cases of IB stage,1 case of IC stage,1 case of ?A stage,1 case of ?B stage,and 1 case of IIIC stage)in 15 patients with uterine adenosaloma.The stage I patients had higher progression-free survival and overall survival than patients with stage ?-?,and the difference was statistically significant(Log-rank P<0.05).7.Preoperative diagnostic rate:through multiple diagnostic curettage pathological diagnosis(1/15),cervical biopsy pathological diagnosis(3/15),hysteroscopy pathological diagnosis(3/15).8.Surgical methods:The basic surgical method was full hysterectomy + double adjunctive resection of the fascia,12 of which underwent total hysterectomy plus double adnexectomy.Two cases of young patients had ovarian retention after ovarian biopsy,8 cases had pelvic lymph node dissection,5 cases had partial omentum resection,and 4 cases had abdominal aortic lymph node sampling.9.Postoperative pathological results:Three cases showed polypoid growth,of which 2 cases invaded the uterus superficial muscularis.4 cases of adenosarcoma metaplasia of mesenchymal tissue,some tumor cells were spindle-shaped,arranged in a bundle,visible nuclear atypical and mitotic figures,including 1 case of mitoses more than 10/10 HPF.Two cases had sarcoma overgrowth,that is,the focal sarcoma had a composition of>25%,and the cells were poorly differentiated.One case was accompanied by atypical differentiation and some were embryonal rhabdomyosarcoma-like differentiation.10.Immunohistochemical phenotype:CK(+)in glandular epithelium.Interstitial components Vimentin(+),CD 10 part(+);1 case with leiomyosarcoma component:SMA(+);2 cases with allogeneic rhabdomyosarcoma:Desmin,MyoD1,Myogenin(+);partial ER,PR(+);Ki67 positive rate of 3%to 90%.11.Postoperative adjuvant chemotherapy:2 cases of patients with stage IB1 cervical adenoma received no adjuvant radiochemotherapy,and the other 13 cases received different courses of chemotherapy.Six patients underwent PIA(cisplatin plus ifosfamide plus epirubicin)for 3 to 6 courses.4 routine PI(cisplatin plus ifosfamide)regimens were used for 1 to 4 courses of treatment,including 1 course of 4 cycles of TP(paclitaxel + cisplatin)regimen after relapse.2 routine TP(paclitaxel + cisplatin)regimen 4 courses.1 routine VCR + KSM + CTX(vincristine + dactinomycin + cyclophosphamide)program 2 treatment courses.12.Postoperative follow-up:Postoperative follow-up has been from 1 to 63 months,with an average follow-up of 25.5 months.None of the 15 patients were lost to follow-up.Four of them died of varying degrees of progression due to disease,and one died of pulmonary embolism after chemotherapy.In 10 patients,no recurrence or metastasis was found.The 1-year survival rate after surgery was 64%.The pathological findings of 5 patients in this group were all associated with high risk factors:muscular infiltration,heterogenous differentiation,lymph node involvement,and sarcoma overgrowth.Conclusion:Uterine adenosarcoma is a relatively rare case,the incidence of which accounted for about 7.98%of uterine sarcoma in our hospital during the same period.The clinical manifestations of the disease are non-specific,mainly irregular vaginal bleeding.Early stage of disease is prone to missed diagnosis or misdiagnosis.Need to identify with a series of benign and malignant lesions,often confirmed by postoperative pathological examination and immunohistochemistry.The disease is common in postmenopausal women,but it can also be found in young women.Although it is a low-grade malignancy,the risk of postoperative recurrence should also be evaluated in detail,especially in patients with combined sarcoma overgrowth,deep muscular infiltration,and heterogenous differentiation. |
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