妊娠合并骨外尤因肉瘤治疗后复发转移成功分娩一例

doi:10.12280/gjfckx.20220237

摘要/Abstract

摘要：

妊娠合并骨外尤因肉瘤（extraskeletal Ewing sarcoma）在临床上十分罕见，复发、转移率极高，目前尚无统一有效的治疗方案。报告1例妊娠合并腹膜后骨外尤因肉瘤，因腰骶部疼痛就诊，既往接受腹膜后骨外尤因肉瘤肿瘤切除术联合左肾切除术，并辅以术后化疗，结合相关病史及检查考虑骨外尤因肉瘤复发、转移，于兰州大学第一医院顺利剖宫产一名健康足月活女婴。由于妊娠合并骨外尤因肉瘤十分罕见，治疗更加困难且预后欠佳，建议临床工作中应对可疑妊娠妇女在定期产检基础上加强随访，及时发现病灶。一旦确诊，需在多学科的共同管理模式下制定治疗策略，以帮助患者克服妊娠期癌症带来的困难，尽可能减少不良结局。

关键词: 肉瘤，Ewing, 妊娠, 剖宫产术, 分娩, 药物疗法，联合

Abstract:

Extraskeletal Ewing sarcoma in pregnancy is very rare in clinic, with a high rate of recurrence and metastasis, and there is no unified and effective treatment plan at present. This paper reports a case of pregnancy complicated with extraperitoneal Ewing sarcoma. Due to lumbosacral pain, a healthy full-term live female infant was successfully cesarean section in the First Hospital of Lanzhou University, who had previously received retroperitoneal tumor resection combined with left nephrectomy, supplemented with postoperative chemotherapy, combined with relevant medical history and examination to consider the recurrence and metastasis of extraperitoneal Ewing sarcoma. Because extraosseous Ewing sarcoma in pregnancy is very rare, the treatment is more difficult and the prognosis is poor. It is suggested that the suspected pregnant women should be followed up on the basis of regular prenatal examination in clinical work to find the focus in time. Once diagnosed, treatment strategies should be developed under the multi-disciplinary joint management mode to help patients overcome the challenges posed by pregnancy associated cancer and minimize adverse outcomes.

Key words: Sarcoma, Ewing, Pregnancy, Cesarean section, Parturition, Drug therapy, combination

马雪影, 叶玲, 王晓慧. 妊娠合并骨外尤因肉瘤治疗后复发转移成功分娩一例[J]. 国际妇产科学杂志, 2022, 49(6): 687-690.

MA Xue-ying, YE Ling, WANG Xiao-hui. Recurrence and Metastasis after Treatment of Extraskeletal Ewing Sarcoma Combined with Pregnancy and Successfully Delivery: A Case Report[J]. Journal of International Obstetrics and Gynecology, 2022, 49(6): 687-690.

图/表 5

图1 2015年左侧腹膜后肿物病理学检查结果（HE染色×100）注:瘤细胞较小，圆形、椭圆形、弥漫排列，形态学符合骨外尤因肉瘤。

图2 子宫后方的产科B超注：子宫后方约114 mm×97 mm不均匀低回声区，边界尚清，形态尚规则，内可见少量血流信号。

图3 胎盘胎膜病理学检查结果（HE染色×40）注：胎盘小叶单位数量如常，部分区域可见淋巴细胞、中性粒细胞浸润，形态学支持胎盘绒毛膜羊膜炎伴灶性坏死。

图4 子宫后方的全腹CT图注：骶前子宫后发现异常强化软组织占位，局部向右侧骶髂关节破入，骶骨、右侧梨状肌、臀大肌、臀中肌、臀小肌受侵。增强扫描轻度强化，内见无强化的低密度影，周围多发淋巴结显示。

图5 子宫后方肿物穿刺病理学检查结果（HE染色×200）注：穿刺组织大部分出血坏死，纤维组织增生，内可见少许异型细胞，呈小圆状、浸润性生长，符合尤因肉瘤。

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