大量腹水合并CA125升高的寄生性平滑肌瘤一例

doi:10.12280/gjfckx.20240156

摘要/Abstract

摘要：

寄生性平滑肌瘤是一种由子宫肌瘤异位植入形成的良性实体肿瘤，极少合并腹水及糖类抗原125（carbohydrate antigen 125，CA125）升高。报告1例罕见的寄生性平滑肌瘤病例，由于并发大量腹水和CA125水平显著升高，同时影像学检查提示存在巨大附件来源包块及盆腹腔多发结节，术前误诊为卵巢恶性肿瘤伴腹膜转移。最终通过手术治疗，患者的症状得到缓解，CA125水平也降至正常范围。提示针对此类患者需充分重视其既往手术及药物史，同时全面结合肿瘤标志物、盆腹腔磁共振成像、腹水生化、细胞学检查以及术中快速冰冻病理进行综合评估以避免误诊。

关键词: 子宫肿瘤, 误诊, 病例报告, 寄生性平滑肌瘤, 医源性疾病

Abstract:

Parasitic leiomyoma is a benign solid tumor formed by ectopic implantation of uterine fibroids, and it is rarely associated with ascites and elevated carbohydrate antigen 125 (CA125). This case reported presents a rare instance of parasitic leiomyoma, which was complicated by massive ascites and significantly elevated CA125 levels. Imaging examination suggested a large adnexal mass and multiple nodules in the pelvic-abdominal cavity, leading to a preoperative misdiagnosis of ovarian malignancy with peritoneal metastasis. The patient′s symptoms were alleviated, and CA125 levels returned to normal following surgical treatment. This case highlights the importance of thoroughly considering the patient′s surgical and medication history, along with a comprehensive evaluation that includes tumor markers, pelvic-abdominal MRI, ascitic fluid biochemical and cytological analysis, and intraoperative frozen section pathology, in order to avoid misdiagnosis.

Key words: Uterine neoplasms, Diagnostic errors, Case reports, Parasitic leiomyoma, Iatrogenic disease

刘彦君, 张颖. 大量腹水合并CA125升高的寄生性平滑肌瘤一例[J]. 国际妇产科学杂志, 2024, 51(5): 588-592.

LIU Yan-jun, ZHANG Ying. A Case of Parasitic Leiomyoma with Massive Ascites and Elevated CA125[J]. Journal of International Obstetrics and Gynecology, 2024, 51(5): 588-592.

图/表 4

图1 患者术前CTA图注：A 横断面。B 矢状位。黄色箭头所示为卵巢肿物，白色箭头所示为盆腹腔结节。

图2 左侧卵巢肿物石蜡病理图注：A HE染色×100，标尺=100 μm。B HE染色×400，标尺=50 μm。

图3 左侧卵巢肿物免疫组织化学染色病理图（免疫组织化学染色×200）注：A Desmin（+）。B SMA（+）。C ER（+）。D PR（+）。标尺=50 μm。

图4 患者术后第11个月MRI图注：A 横断面；B 矢状位。黄色箭头指向盆腔结节。

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