早期子宮惡性肌肉瘤復發併肺部轉移：治療策略之回顧

Early-staged leiomyosarcoma recurrence with lung metastasis: a review of current treatment strategy

子宮惡性肌肉瘤為子宮體最常見之惡性肉瘤，由於影像學檢查無法有效的區別良性肌瘤與惡性肌肉瘤，即使術中冰凍切片也難辨別，故子宮惡性肌肉瘤的診斷常常在術後的病理才被確認，導致手術切除範圍不足，導致病人不良的預後。我們呈現了一位術前診斷為良性子宮肌瘤的48歲女性患者，在行肌瘤切除術中，因腫瘤質地軟爛而送冰凍切片，報告呈現惡性肌肉瘤。雖然當下馬上進行完整的分期手術，最終病理分期為FIGO IB，並於術後行全骨盆腔放射治療，病人仍於術後五個月出現肺部轉移。本文也將回顧早期子宮惡性肌肉瘤的治療策略，討論是否在早期子宮惡性肌肉瘤的患者給予術後化療與放射線治療。

Leiomyosarcoma is the most common sarcoma subtype of the uterine corpus, account up to 60% of uterine sarcoma. Due to similar appearance on image studies, most of the time leiomyosarcoma are indistinguishable from its benign counterpart, leiomyoma, even during intra-operative frozen section. It is not uncommon for the diagnosis of leiomyosarcoma to be made after the surgery, which might be the resection of tumor rather than complete hysterectomy, leading to even poorer prognosis. We hereby present a case, a 48 year old woman whose preoperative diagnosis was uterine leiomyoma. During myomectomy, intra-operative frozen section was obtained due to necrotic content of the tumor. As pathologist confirmed the diagnosis of leiomyosarcoma, we convert the procedure to complete staging immediately. The final pathological staging was FIGO IB, and whole pelvic external beam radiation therapy was arranged for the fear of local recurrence. Despite all the effort, multiple pleural and pulmonary metastasis emerged five months after the surgery. Review of current treatment strategy regarding early-staged leiomyosarcoma was done. In conclusion, despite high distant metastasis rate even in early stage diseases, adjuvant radiation and chemotherapy do not seem to improve overall survival.