子宫伴奇异形核平滑肌瘤一例

doi:10.12280/gjfckx.20241000

摘要/Abstract

摘要：

子宫伴奇异形核平滑肌瘤（uterine leiomyoma with bizarre nucleus，ULBN）是一种罕见的子宫肌瘤亚型，因其与子宫平滑肌肉瘤（leiomyosarcoma，LMS）、延胡索酸水合酶缺陷型子宫平滑肌瘤[fumarate hydratase （FH）-deficient uterine leiomyoma，FH-d UL]拥有相似的病理学表现，故临床不易鉴别，仍依赖排除性诊断。报道广州中医药大学第一附属医院收治的1例以“下腹部肿物突出”为首发症状的ULBN患者。因患者为年轻的育龄期女性，有生育要求，故为其行腹式子宫肌瘤剔除术。通过总结该病的临床特征、分析其术后病理结果和免疫组织化学结果，加深临床医生对此病的认识，提高诊治、鉴别能力。

关键词: 平滑肌瘤, 免疫组织化学, 诊断, 诊断，鉴别, 子宫伴奇异形核平滑肌瘤

Abstract:

Uterine leiomyoma with bizarre nucleus (ULBN) is a rare subtype of uterine leiomyoma. It is not easy to distinguish clinically because of its similar pathologic manifestations to leiomyosarcoma (LMS) and fumarate hydratase (FH)-deficient uterine leiomyoma (FH-d UL), and the diagnosis of exclusion is still relied upon. This article reports a case of ULBN treated at the First Affiliated Hospital of Guangzhou University of Chinese Medicine, who sought medical advice with a protruding lower abdominal mass as the first symptom. Because the patient was a young woman of childbearing age with fertility requirement, so she underwent laparotomy myomectomy. By summarizing the clinical characteristics of the disease and analyzing its postoperative pathological results and immunohistochemistry, the clinical understanding of the disease will be deepened and the ability to diagnose, treat and distinguish will be improved.

Key words: Leiomyoma, Immunohistochemistry, Diagnosis, Diagnosis, differential, Uterine leiomyoma with bizarre nucleus

陈淑婉, 邓高丕, 袁烁. 子宫伴奇异形核平滑肌瘤一例[J]. 国际妇产科学杂志, 2025, 52(2): 187-190.

CHEN Shu-wan, DENG Gao-pi, YUAN Shuo. A Case of Uterine Leiomyoma with Bizarre Nucleus[J]. Journal of International Obstetrics and Gynecology, 2025, 52(2): 187-190.

图/表 1

参考文献 22

[1]	徐惠成, 梁志清. 容易误诊为子宫肉瘤的肌瘤类型[J]. 实用妇产科杂志, 2012, 28(1):17-19. doi: 10.3969/j.issn.1003-6946.201201.009.
[2]	Tavassoli FA, Devilee P. The World Health Organization classification of tumors: pathology & genetics of tumour of the breast and female genital organs[M]. 3rd ed. Lyon: IARC, 2003:217-257.
[3]	Downes KA, Hart WR. Bizarre leiomyomas of the uterus: a compre-hensive pathologic study of 24 cases with long-term follow-up[J]. Am J Surg Pathol, 1997, 21(11):1261-1270. doi: 10.1097/00000478-199711000-00001. pmid: 9351564
[4]	Hanley KZ, Birdsong GG, Mosunjac MB. Recent Developments in Surgical Pathology of the Uterine Corpus[J]. Arch Pathol Lab Med, 2017, 141(4):528-541. doi: 10.5858/arpa.2016-0284-SA. pmid: 28353387
[5]	Muezzinoglu B, Corakci A. Pathological characteristics and clinical outcome of uterine leiomyomas associated with pregnancy[J]. Pathol Res Pract, 2011, 207(11):691-694. doi: 10.1016/j.prp.2011.09.001. pmid: 21993296
[6]	罗冬云, 郑兴征, 钟萍萍, 等. 女性生殖系统平滑肌肉瘤13例临床病理分析[J]. 临床与病理杂志, 2024, 44(4):532-539. doi: 10.11817/j.issn.2095-6959.2024.240101.
[7]	WHO Classification of Tumours Editorial Board. WHO classification of tumours: female genital tumours[M]. Lyon: IARC, 2020:1-632.
[8]	杨国仪, 周晓军, 孟奎, 等. 免疫组化标记在子宫间质肿瘤诊断中的应用价值[J]. 临床与实验病理学杂志, 2004, 20(5):537-540. doi: 10.3969/j.issn.1001-7399.2004.05.007.
[9]	陈晓露, 曾祥麒, 吴红樱. 子宫内膜间质肉瘤24例的特异性标志物及临床病理分析[J]. 现代预防医学, 2011, 38(11):2194-2195,2198.
[10]	甘岫云, 赵茜, 李显贵, 等. 子宫平滑肌肿瘤免疫组织化学的研究[J]. 中华妇产科杂志, 1994, 29(1):47-48.
[11]	冷旭, 王敏. SMA、Desmin、CD10和Vimentin在特殊类型子宫肿瘤诊断中的应用[J]. 肿瘤学杂志, 2011, 17(11):812-814.
[12]	朱雪琼, 石一复, 陈晓端, 等. 子宫平滑肌肉瘤与特殊类型良性平滑肌瘤的鉴别[J]. 中华医学杂志, 2003, 83(16): 1419-1421. doi: 10.3760/j:issn:0376-2491.2003.16.013..
[13]	Valencia-Guerrero A, Pinto A, Anderson WJ, et al. PNL2: A Useful Adjunct Biomarker to HMB45 in the Diagnosis of Uterine Perivascular Epithelioid Cell Tumor (PEComa)[J]. Int J Gynecol Pathol, 2020, 39(6):529-536. doi: 10.1097/PGP.0000000000000653.
[14]	Machado-Lopez A, Simón C, Mas A. Molecular and Cellular Insights into the Development of Uterine Fibroids[J]. Int J Mol Sci, 2021, 22(16):8483. doi: 10.3390/ijms22168483.
[15]	Rubisz P, Ciebiera M, Hirnle L, et al. The Usefulness of Immuno-histochemistry in the Differential Diagnosis of Lesions Originating from the Myometrium[J]. Int J Mol Sci, 2019, 20(5):1136. doi: 10.3390/ijms20051136.
[16]	Delgado B, Dreiher J, Braiman D, et al. P16, Ki67, P53, and WT1 Expression in Uterine Smooth Muscle Tumors: An Adjunct in Confirming the Diagnosis of Malignancy in Ambiguous Cases[J]. Int J Gynecol Pathol, 2021, 40(3):257-262. doi: 10.1097/PGP.0000000000000688.
[17]	Dastranj Tabrizi A, Ghojazadeh M, Thagizadeh Anvar H, et al. Immunohistochemical Profile of Uterine Leiomyoma With Bizarre Nuclei; Comparison With Conventional Leiomyoma, Smooth Muscle Tumors of Uncertain Malignant Potential and Leiomyosarcoma[J]. Adv Pharm Bull, 2015, 5(Suppl 1):683-687. doi: 10.15171/apb.2015.093. pmid: 26793616
[18]	Ünver NU, Acikalin MF, Öner Ü, et al. Differential expression of P16 and P21 in benign and malignant uterine smooth muscle tumors[J]. Arch Gynecol Obstet, 2011, 284(2):483-490. doi: 10.1007/s00404-010-1690-z. pmid: 20878171
[19]	Joseph NM, Solomon DA, Frizzell N, et al. Morphology and Immuno-histochemistry for 2SC and FH Aid in Detection of Fumarate Hydratase Gene Aberrations in Uterine Leiomyomas From Young Patients[J]. Am J Surg Pathol, 2015, 39(11):1529-1539. doi: 10.1097/PAS.0000000000000520. pmid: 26457356
[20]	Gregová M, Hojný J, Němejcová K, et al. Leiomyoma with Bizarre Nuclei: a Study of 108 Cases Focusing on Clinicopathological Features, Morphology, and Fumarate Hydratase Alterations[J]. Pathol Oncol Res, 2020, 26(3):1527-1537. doi: 10.1007/s12253-019-00739-5. pmid: 31471882
[21]	Boudová B, Mára M, Dundr P, et al. Uterine leiomyomas with bizarre nuclei: analysis of 37 cases after laparoscopic or open myomectomy[J]. Ceska Gynekol, 2019, 84(5):324-330. pmid: 31826627
[22]	Ly A, Mills AM, McKenney JK, et al. Atypical leiomyomas of the uterus: a clinicopathologic study of 51 cases[J]. Am J Surg Pathol, 2013, 37(5):643-649. doi: 10.1097/PAS.0b013e3182893f36. pmid: 23552381