患者女性,44岁,已婚已育,因“子宫肌瘤2次剔除术后8年,经量增多1年”于2022年10月29日入院,查体示:外阴发育正常,阴道通畅,宫颈暴露困难,光滑,宫体前位,如孕5个月大小,形态不规则,质中,活动可,无压痛。双侧附件区未扪及明显异常。辅助检查:① 妇科超声:子宫前位,约15.8 cm × 11.0 cm × 10.2 cm,包膜欠光滑,外形欠规则,肌层回声不均匀,肌层内见多发低回声结节及团块,较大者右后壁下段8.8 cm × 5.8 cm (外凸),均边界清;② 血红蛋白:94 g/L。术后病理提示:家族遗传性平滑肌瘤。
前言:恶性潜能未定的子宫平滑肌瘤(Uterine smooth muscle tumor of uncertain malignant potential, STUMP)由于其高度的异质性,通常被认为是从平滑肌瘤向平滑肌肉瘤的过渡。虽然大多数研究表明恶性潜能未定的子宫平滑肌瘤(STUMP)的特点是生长较慢,通常延迟复发,但与平滑肌肉瘤相比预后较好。仍然有一些案例以其恶性的生物行为而闻名。病例报告:我们报告一位43岁的女性患者,在外院首次接受腹腔镜下子宫肌瘤切除术8年后,表现为由于巨大的腹腔转移引起的剧烈腹痛伴肿瘤破裂出血在我院接受治疗。在这期间患者反复复发并进行多次手术治疗,并在最近一次手术中高度怀疑恶性潜能不确定的平滑肌肿瘤(STUMP)发生向平滑肌肉瘤转变。我们成功地进行了腹腔及腹壁肿物切除术和腹腔热灌注治疗术。术后组织病理诊断:符合恶性潜能未定的平滑肌肿瘤(STUMP)以高级别平滑肌肉瘤发生恶变。结论:由于这种肿瘤的罕见,其病因、预后因素、临床结果和复发风险尚不清楚。这些肿瘤一旦复发,可能会有侵袭性的临床病程,与局部和远程复发甚至死亡有关。因此,被诊断为恶性潜能未定的子宫肌瘤的患者应接受长期监测。Introduction: Recurrent Uterine smooth muscle tumors of uncertain malignant potential (STUMP) are generally identified as a transition from leiomyoma to leiomyosarcoma due to its high heterogeneity. Although most studies have shown that STUMP is characterized by slower growth and usually delayed recurrence, its prognosis is better than leiomyosarcoma. There are still some cases that are known for their vicious biological behavior. Case report: We report the case of a 43-year-old woman patient who presented at our hospital with severe abdominal pain due to an enormous abdominal metastasis and tumor rupture hemorrhage 8 years after initial laparoscopic myomectomy in another hospital. During this period, the patient repeatedly r
