输卵管癌肉瘤合并子宫内膜癌一例并文献复习

doi:10.12280/gjfckx.20200546

摘要/Abstract

摘要：

输卵管癌肉瘤又称恶性中胚叶混合瘤或恶性苗勒管混合瘤（malignant mixed müllerian tumor,MMMT）,临床上十分罕见,恶性程度高,预后差。其临床表现不典型,可以出现与其他妇科肿瘤类似的阴道不规则出血、腹痛或腹胀等症状,辅助检查无特异性,术前易误诊或漏诊,治疗方式以手术为主,术后给予以铂类为基础的联合化疗。现报告1例罕见输卵管癌肉瘤合并子宫内膜癌,通过文献复习进一步增加临床对输卵管癌肉瘤的认识。

关键词: 输卵管肿瘤, 肉瘤, 免疫组织化学, 治疗, 预后, 误诊

Abstract:

Fallopian tube carcinosarcoma, also known as malignant embryonic leaf mixed tumor or malignant mixed müllerian tumor (MMMT), is very rare clinically, with high malignancy and poor prognosis. The clinical symptoms are not typical, such as irregular vaginal bleeding, abdominal pain or abdominal distention similar to other gynecological tumors, auxiliary examination is not specific, and preoperative misdiagnosis or missed diagnosis is easy. The treatment is mainly surgery, followed by platinum-based combined chemotherapy. This paper reports a case of fallopian tube carcinosarcoma and endometrial cancer, and increase the recognition of fallopian tube carcinosarcoma by reviewing literature.

Key words: Fallopian tube neoplasms, Sarcoma, Immunohistochemistry, Therapy, Prognosis, Diagnostic errors

孙森森, 刘盈盈, 吕荣荣, 付莉. 输卵管癌肉瘤合并子宫内膜癌一例并文献复习[J]. 国际妇产科学杂志, 2021, 48(2): 165-168.

SUN Sen-sen, LIU Ying-ying, LYU Rong-rong, FU Li. Fallopian Tube Carcinosarcoma and Endometrial Cancer: A Case Report and Literature Review[J]. Journal of International Obstetrics and Gynecology, 2021, 48(2): 165-168.

图/表 1

参考文献 15

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病例	分期	手术方式	术后辅助治疗	预后
1	Ⅱa期	全子宫切除术+双侧附件切除术+大网膜切除术	卡铂和紫杉醇化疗（6个周期）和辅助放疗+阿霉素治疗（2个周期）	术后12个月死亡
2	Ⅱc期	同病例1+盆腔及腹主动脉淋巴结清除术（阑尾切除手术史）+肿瘤细胞减灭术	连续6个周期紫杉醇（175 mg/m²）+卡铂（AUC5）治疗	追踪至术后15个月,存活
3	Ⅲa期	同病例1+盆腔淋巴结清除术+肿瘤细胞减灭术	6个周期阿霉素（45 mg/m²）联合化疗+顺铂（50 mg/m²）+紫杉醇（160 mg/m²）	追踪至术后8个月,存活
4	Ⅱa期	右侧附件切除术+大网膜切除术+阑尾切除术+盆腔淋巴结清扫和主动脉旁淋巴结活检（子宫及左侧附件手术史）	（首次）紫杉醇（175 mg/m²）及奥沙利铂（130 mg/m²）治疗+后续紫杉醇（175 mg/m²）及顺铂（75 mg/m²）治疗+中医治疗	追踪至术后16个月,存活
5	Ⅲc期	同病例1+阑尾切除术+盆腔及腹主动脉淋巴结清除术+肿瘤细胞减灭术	连续6个周期紫杉醇（175 mg/m²）+卡铂（AUC 5）治疗	追踪至术后5年,存活
6	Ⅲc期	全子宫及双侧附件切除术+乙状结肠切除、直肠节段切除+肿瘤细胞减灭术	9个疗程IEP治疗（异环磷酰胺+盐酸表柔比星+顺铂）	追踪至术后45个月,存活
7	Ⅲc期	同病例1+盆腔淋巴结清除术	6个疗程TC（多西他赛+卡铂）治疗	追踪至术后27个月,存活
8	Ⅱc期	全子宫切除术和腹主动脉吻合术	IEP 9个疗程+TC 6个疗程	追踪至术后38个月,存活
9	Ⅲc期	同病例1+乙状结肠切除+升结肠切除+右侧输尿管部分切除	IEP 6个疗程	追踪至术后5个月,存活
10	Ⅲc期	同病例1+阑尾切除术+盆腔及腹主动脉淋巴结清除术+肿瘤细胞减灭术	6个疗程联合铂类化疗	追踪至术后6个月,存活
11	Ⅲc期	同病例1+阑尾切除术+盆腔淋巴结清除术+肿瘤细胞减灭术	以顺铂为基础的化疗	术后未定期随访
12	Ⅱb期	同病例1+盆腔淋巴结清除术	6个疗程紫杉醇（500 mg）+卡铂（270 mg）治疗	追踪至术后6个月,存活
13	Ⅱb期	同病例1+阑尾切除术	未化疗	术后未定期随访

病例	分期	手术方式	术后辅助治疗	预后
1	Ⅱa期	全子宫切除术+双侧附件切除术+大网膜切除术	卡铂和紫杉醇化疗（6个周期）和辅助放疗+阿霉素治疗（2个周期）	术后12个月死亡
2	Ⅱc期	同病例1+盆腔及腹主动脉淋巴结清除术（阑尾切除手术史）+肿瘤细胞减灭术	连续6个周期紫杉醇（175 mg/m²）+卡铂（AUC5）治疗	追踪至术后15个月,存活
3	Ⅲa期	同病例1+盆腔淋巴结清除术+肿瘤细胞减灭术	6个周期阿霉素（45 mg/m²）联合化疗+顺铂（50 mg/m²）+紫杉醇（160 mg/m²）	追踪至术后8个月,存活
4	Ⅱa期	右侧附件切除术+大网膜切除术+阑尾切除术+盆腔淋巴结清扫和主动脉旁淋巴结活检（子宫及左侧附件手术史）	（首次）紫杉醇（175 mg/m²）及奥沙利铂（130 mg/m²）治疗+后续紫杉醇（175 mg/m²）及顺铂（75 mg/m²）治疗+中医治疗	追踪至术后16个月,存活
5	Ⅲc期	同病例1+阑尾切除术+盆腔及腹主动脉淋巴结清除术+肿瘤细胞减灭术	连续6个周期紫杉醇（175 mg/m²）+卡铂（AUC 5）治疗	追踪至术后5年,存活
6	Ⅲc期	全子宫及双侧附件切除术+乙状结肠切除、直肠节段切除+肿瘤细胞减灭术	9个疗程IEP治疗（异环磷酰胺+盐酸表柔比星+顺铂）	追踪至术后45个月,存活
7	Ⅲc期	同病例1+盆腔淋巴结清除术	6个疗程TC（多西他赛+卡铂）治疗	追踪至术后27个月,存活
8	Ⅱc期	全子宫切除术和腹主动脉吻合术	IEP 9个疗程+TC 6个疗程	追踪至术后38个月,存活
9	Ⅲc期	同病例1+乙状结肠切除+升结肠切除+右侧输尿管部分切除	IEP 6个疗程	追踪至术后5个月,存活
10	Ⅲc期	同病例1+阑尾切除术+盆腔及腹主动脉淋巴结清除术+肿瘤细胞减灭术	6个疗程联合铂类化疗	追踪至术后6个月,存活
11	Ⅲc期	同病例1+阑尾切除术+盆腔淋巴结清除术+肿瘤细胞减灭术	以顺铂为基础的化疗	术后未定期随访
12	Ⅱb期	同病例1+盆腔淋巴结清除术	6个疗程紫杉醇（500 mg）+卡铂（270 mg）治疗	追踪至术后6个月,存活
13	Ⅱb期	同病例1+阑尾切除术	未化疗	术后未定期随访