年輕女性的子宮內膜基質惡性肉瘤

Endometrial stromal sarcoma of the young woman

子宮惡性肉瘤，一般都發生在停經附近年紀的婦女身上，又可區分為平滑肌惡性肉瘤，子宮內膜基質肉瘤及未分化肉瘤。子宮內膜基質肉瘤，又分為高度及低度子宮內膜基質肉瘤。這些肉瘤，相對於子宮體癌來說，屬於少見的子宮肉瘤，這其中又以平滑肌惡性肉瘤，較為常見。不管是平滑肌惡性肉瘤，子宮內膜基質肉瘤及未分化肉瘤，都很難單靠影像學來判斷，所以術前的診斷極為困難。常常診斷都來自最後的病理報告。本案例是一位27歲女性，在外院診斷為子宮腺肌症，因此施行了全子宮切除術，最終病理報告為低度惡性子宮內膜基質肉瘤，考量到卵巢切除在此疾病的重要性，病人在一個月後接受了第二次手術，切除了雙側卵巢輸卵管，因為腹腔內粘連厲害，疾病的嚴重程度，很難區分，所以沾黏部分，也做了切片，包括一些淋巴結，及沾黏或部分網膜部分，最後所有的第二次手術切下來的病理標本都沒有剩餘的腫瘤存在或轉移。在手術後，根據世界婦產科聯盟（FIGO）及美國臨床癌症協會（AJCC）系統，她的最後手術病理分期為Ib（T1bN0M0）。回顧過去，小於三十歲的此類惡性腫瘤報告數量並不多，本篇將就此案例進行探討。

Uterine sarcomas include leiomyosarcoma, endometrial stromal sarcoma (ESS) and undifferentiated uterine sarcoma. ESS is further separated into low-grade and high-grade ESS. It is difficult to make an accurate diagnosis of the uterine sarcomas before the definite surgery, even though there are modern imaging systems available. The current report is a 27-year-old woman with low-grade ESS after total hysterectomy for the supposed uterine adenomyosis. Due to the absence of removal of the ovary, the patient underwent the secondary surgery to remove all suspicious lesions, including bilateral tubes and ovaries. The final surgico-pathological stage was IB. Since the current clinical situation is rare, we discuss the clinical characteristics, treatment, and outcome of this patient.