高级别子宫内膜间质肉瘤与子宫内膜样腺癌碰撞瘤一例

doi:10.12280/gjfckx.20251162

摘要/Abstract

摘要：

碰撞瘤是指两种及以上独立组织来源的原发性肿瘤共存于同一解剖部位，且无相互移行。报道1例罕见的晚期高级别子宫内膜间质肉瘤同步子宫内膜样腺癌病例，患者为51岁女性，因下腹部胀痛入院，影像学提示巨大盆腔实性占位，伴多发脏器转移、下腔静脉受侵并疑似癌栓形成，术后病理确诊高级别子宫内膜间质肉瘤ⅣB期合并高分化子宫内膜样腺癌，基因检测提示TP53突变。尽管接受了肿瘤细胞减灭术并辅以化疗，患者术后约2个月即出现阴道残端复发并广泛肿瘤进展。本病例结合文献复习提示，对于影像学表现复杂、临床进展极快且累及范围广泛的盆腔肿瘤，应考虑到罕见病理组合的可能，同时也凸显了基于分子分型开发个体化治疗新策略的迫切性，以期改善此类患者的预后。

关键词: 肉瘤，子宫内膜间质, 子宫内膜肿瘤, 癌, 碰撞瘤, 多学科诊疗, 治疗

Abstract:

A Collision tumor refers to the coexistence of two or more primary tumors of distinct histological origins in the same anatomical site without mutual transition. We report a rare case of an advanced high-grade endometrial stromal sarcoma coexisting synchronously with endometrioid adenocarcinoma. The patient was a 51-year-old female admitted with lower abdominal distension and pain. Imaging revealed a large solid pelvic mass accompanied by multiple organ metastases, invasion of the inferior vena cava, and suspected tumor thrombus. Postoperative pathology confirmed high-grade endometrial stromal sarcoma (stage ⅣB) combined with well-differentiated endometrioid adenocarcinoma. Genetic testing indicated a TP53 mutation. Despite undergoing cytoreductive surgery and adjuvant chemotherapy, the patient developed recurrence at the vaginal stump and widespread tumor progression approximately two months after surgery. Through analysis of this case and literature review, we suggest that for pelvic tumors presenting with complex imaging features, extremely rapid clinical progression, and extensive involvement, the possibility of rare pathological combinations should be considered. This case also highlights the urgent need to develop individualized therapeutic strategies based on molecular subtyping to improve the prognosis of such patients.

Key words: Sarcoma, endometrial stromal, Endometrial neoplasms, Carcinoma, Collision tumor, Multi-disciplinary team, Therapy

尹第霜, 李囡, 郭红霞. 高级别子宫内膜间质肉瘤与子宫内膜样腺癌碰撞瘤一例[J]. 国际妇产科学杂志, 2026, 53(3): 311-317.

YIN Di-shuang, LI Nan, GUO Hong-xia. Collision Tumor Composed of High-Grade Endometrial Stromal Sarcoma and Endometrioid Adenocarcinoma: A Case Report[J]. Journal of International Obstetrics and Gynecology, 2026, 53(3): 311-317.

图/表 5

图1 患者术前影像学检查图注：A 术前全腹MRI扫描提示下腔静脉旁见一个团状占位，边缘清晰，与邻近下腔静脉分界不清，相应管腔变窄；B 术前经阴道超声提示子宫后方直肠陷凹处见一实性低回声团，形态欠规则，与后壁中上段肌层分界不清（图中m代表肿块所在位置）。

图2 术中所见及标本剖面图注：A 标本大体，局灶内膜增厚，子宫后壁显著增厚，呈漩涡状，见出血点，肌壁间见一灰白色结节，浆膜侧灰白灰黄色肿物向外突破；B 术中探查见下腔静脉旁肿大淋巴结，静脉腔内未见明显癌栓。

图3 术后病理图注：A HG-ESS见特征异型的梭形细胞，核圆形/卵圆形，异型性显著，可见病理性核分裂象，HE染色×400，标尺=50 μm；B EAC腺体紧密相连，“背靠背”样排列，细胞核呈假复层，HE染色×200，标尺=100 μm。

图4 患者血清CA125和CA19-9变化趋势

图5 阴道复发超声及病理图注：A 超声阴道残端见一不均质回声团，边界不清，形态不规则；B 病理镜下见显著异型的肿瘤细胞片状、束状排列，肿瘤细胞呈上皮样、梭形，散在瘤巨细胞，HE染色×400，标尺=50 μm。

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