恶性潜能未定的子宫平滑肌瘤:现状与争议

doi:10.12280/gjfckx.20200665

摘要/Abstract

摘要：

恶性潜能未定的子宫平滑肌瘤（uterine smooth muscle tumor of uncertain malignant potential,STUMP）是一类区别于良性子宫平滑肌瘤和恶性子宫平滑肌肉瘤的子宫交界性平滑肌瘤,发病率较低。其临床特征及影像学表现均缺乏特异性,多数情况下生长缓慢、预后良好,但实际病程难以预测,存在一定的复发、恶变风险。STUMP的诊断有赖于组织病理学检查,但是目前尚无统一的病理诊断标准,争议较大。免疫组织化学分子分型及基因组分析可能对评估预后提供一定的帮助,但证据十分有限,有待进一步研究。虽然尚无指南或共识规范STUMP的治疗,对于已完成生育的患者,全子宫切除术是公认的标准治疗方法;而对于有生育需求的患者,则可以有选择地进行保留生育功能手术。术后规律随访是及时发现漏诊和肿瘤复发的重要保障。

关键词: 恶性潜能未定的子宫平滑肌瘤, 子宫肿瘤, 平滑肌瘤, 诊断, 治疗, 分子标记物, 肿瘤与生殖结局

Abstract:

Uterine smooth muscle tumor of uncertain malignant potential (STUMP) is the neoplasm with pathological features that preclude an equivocal diagnosis of leiomyosarcoma, but that do not fulfill the criteria for leiomyoma or its variants, and raise concerns that the tumor may behave in a malignant fashion. The incidence of STUMP is relatively low. The clinical features and imaging manifestations of STUMP are lack of specificity. In most cases, STUMP grow slowly, and the prognosis is worth expecting. However, the actual course of this disease is difficult to predict, and there is a risk of recurrence and malignant transformation. The diagnosis of STUMP depends solely on histopathological examination, but no consensus has been reached on pathological diagnostic criteria. Immunohistochemical molecular typing and genomic analysis may be helpful for the assessment of prognosis factors, but the evidence is limited and further researches are needed. Although there are no guidelines or consensus governing the treatment of STUMP, total hysterectomy with or without bilateral salpingo-oophorectomy is the standard treatment if fertility is completed, whereas myomectomy alone can be taken into consideration in young patients who desire to preserve childbearing potential. Regular follow-up after surgery is important to detect missed diagnosis and tumor recurrence in time.

Key words: Uterine smooth muscle tumor of uncertain malignant potential, Uterine neoplasms, Leiomyoma, Diagnosis, Therapy, Molecular markers, Oncologic and reproductive outcomes

孙馥箐, 沈明虹, 汪沙, 段华. 恶性潜能未定的子宫平滑肌瘤:现状与争议[J]. 国际妇产科学杂志, 2021, 48(1): 35-40.

SUN Fu-qing, SHEN Ming-hong, WANG Sha, DUAN Hua. Uterine Smooth Muscle Tumor of Uncertain Malignant Potential: Status and Controversy[J]. Journal of International Obstetrics and Gynecology, 2021, 48(1): 35-40.

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