宫颈囊性腺肌瘤一例

doi:10.12280/gjfckx.20251364

摘要/Abstract

摘要：

宫颈囊性腺肌瘤是子宫腺肌病的少见亚型，其病理特征为宫颈肌层内形成由平滑肌包绕的囊性病灶，囊内含陈旧性血液。该病缺乏特异性临床表现，常以顽固性痛经、盆腔痛或月经不调就诊，影像学表现多样，术前诊断困难。报告1例24岁未婚女性宫颈囊性腺肌瘤病例。患者因进行性痛经16个月就诊，MRI提示宫颈前壁多房囊性病灶，囊间分隔清晰T2加权成像，内部呈高信号，未与宫腔相通。行膀胱镜检查术+腹腔镜下宫颈病损切除术，囊内见巧克力样陈旧血液。术后病理确诊为宫颈囊性腺肌瘤。术后给予促性腺激素释放激素激动剂（gonadotropin-releasing hormone agonist，GnRH-a）治疗3个周期，随访6个月未见复发，痛经明显缓解。本例经验表明，结合MRI术前评估、腹腔镜下精细化切除及术后GnRH-a辅助治疗，可安全有效地消除病灶并保留患者生育功能。

关键词: 子宫颈, 囊性腺肌瘤, 磁共振成像, 腹腔镜检查, 生育力

Abstract:

Cervical cystic adenomyoma is a rare subtype of adenomyosis. Its pathological characteristics include the formation of cystic lesions containing old hemorrhage, surrounded by smooth muscle within the cervical myometrium. The condition lacks specific clinical manifestations and often presents with refractory dysmenorrhea, pelvic pain, or menstrual irregularities. Its imaging findings are varied, making preoperative diagnosis difficult. A case of cervical cystic adenomyoma in a 24-year-old unmarried woman is reported. The patient presented with progressive dysmenorrhea for 16 months. MRI revealed a multilocular cystic lesion in the anterior cervix, with hyperintense internal content (on T2-weighted images), clear septations between cysts, and no communication with the uterine cavity. Cystoscopy combined with laparoscopic excision of the cervical lesion was performed. Chocolate-like old blood was found within the cyst. Postoperative pathological examination confirmed the diagnosis of cervical cystic adenomyoma. The patient received adjuvant therapy with a gonadotropin-releasing hormone agonist (GnRH-a) for three cycles after surgery. Follow-up at six months showed no recurrence, and dysmenorrhea was significantly relieved. The experience from this case suggests that combining preoperative MRI assessment, meticulous laparoscopic excision, and postoperative adjuvant GnRH-a therapy can safely and effectively eliminate the lesion while preserving the patient's fertility.

Key words: Cervix uteri, Cystic adenomyoma, Magnetic resonance imaging, Laparoscopy, Fertility

张莹, 史梦茹, 李涛. 宫颈囊性腺肌瘤一例[J]. 国际妇产科学杂志, 2026, 53(3): 318-321.

ZHANG Ying, SHI Meng-ru, LI Tao. A Case of Cervical Cystic Adenomyoma[J]. Journal of International Obstetrics and Gynecology, 2026, 53(3): 318-321.

图/表 4

图1 盆腔CT图注：宫颈前壁见一以液性低密度为主的混杂密度灶，其内有分隔，如箭头所示。

图2 盆腔MRI图注：A 矢状面，B 水平面，T2加权成像示宫颈前壁囊性病灶，呈高信号，囊间分隔清晰，如箭头所示。

图3 腹腔镜探查图注：可见宫颈前壁囊性病变，内含巧克力样液体，如箭头所示。

图4 宫颈肿物病理图注：囊壁由平滑肌及子宫内膜腺体、间质构成；HE染色×200，标尺=50 μm。

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