子宫静脉血管平滑肌瘤病的超声特征分析

doi:10.3877/cma.j.issn.1672-6448.2017.08.012

中华医学超声杂志（电子版） ›› 2017, Vol. 14 ›› Issue (08) : 630 -635. doi: 10.3877/cma.j.issn.1672-6448.2017.08.012

所属专题：妇产科超声影像学；文献；妇产科超声；

妇产科超声影像学

子宫静脉血管平滑肌瘤病的超声特征分析

刘爽¹, 吴青青¹, 詹阳², 许阡³, 陈照娟⁴^,^†(

)

^1. 100026　首都医科大学附属北京妇产医院超声科
^2. 100026　首都医科大学附属北京妇产医院病理科
^3. 100026　首都医科大学附属北京妇产医院微创中心
^4. 100026　首都医科大学附属北京妇产医院妇科

收稿日期:2017-04-27 出版日期:2017-08-01
通信作者: 陈照娟
基金资助:
北京市医院管理局"登峰"计划专项经费资助(DFL20151302); 首都卫生发展科研专项(首发2014-2-2113)

Diagnosis and differential diagnosis of uterine intravenous leiomyomatosis on sonography

Shuang Liu¹, Qingqing Wu¹, Yang Zhan², Qian Xu³, Zhaojuan Chen⁴^,^†()

^1. Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
^2. Department of Pathology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
^3. Department of Hysteroscopic Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
^4. Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China

Received:2017-04-27 Published:2017-08-01
Corresponding author: Zhaojuan Chen
About author:
Corresponding author: Chen Zhaojuan, Email: chenzhaojuan@hotmail.com

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引用本文：

刘爽, 吴青青, 詹阳, 许阡, 陈照娟. 子宫静脉血管平滑肌瘤病的超声特征分析[J]. 中华医学超声杂志（电子版）, 2017, 14(08): 630-635.

Shuang Liu, Qingqing Wu, Yang Zhan, Qian Xu, Zhaojuan Chen. Diagnosis and differential diagnosis of uterine intravenous leiomyomatosis on sonography[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2017, 14(08): 630-635.

目的

总结子宫静脉血管平滑肌瘤病（IVL）的超声影像学特征及鉴别诊断要点。

方法

对2014年1月至2016年12月在首都医科大学附属北京妇产医院超声检查并经临床手术及病理免疫组化染色证实为IVL患者的超声声像图特征及超声鉴别诊断要点进行总结分析。

结果

6例IVL患者中，3例为实体型IVL，表现为宫颈及子宫旁区域的实性肿物，内部见不规则裂隙状血管回声，彩色多普勒可探及静脉血流信号；3例为静脉型IVL，表现为沿子宫静脉走行的串珠状中等回声肿物附着于扩张的静脉管腔内壁。其中1例术前超声及血管超声显示髂静脉内瘤栓正确提示为子宫IVL，术中超声心动图显示下腔静脉血管及下腔静脉近心段同时伴发活动性瘤栓型IVL。其余5例术前超声误诊为阔韧带肌瘤2例、宫颈肌瘤2例、卵巢实性肿物1例，手术病理检查证实均为子宫IVL。

结论

子宫IVL表现为分布于宫颈及子宫旁区域沿子宫静脉走行的实性肿物，部分IVL沿静脉管腔内部蔓延性生长至髂静脉及下腔静脉。实体型IVL易误诊为子宫平滑肌瘤或卵巢实性肿物，实性肿物内部呈现多发裂隙状无回声为超声诊断IVL的重要依据。经阴道超声联合下腔静脉血管超声及超声心动图检查对IVL的诊断有更明显的优势。

关键词: 超声检查, 静脉平滑肌瘤病, 子宫

Objective

Uterine intravenous leiomyomatosiswas a rare type of uterus tumors. Because ofthe lack of knowledge about the ultrasonic patterns of this kind of disease, misdiagnosis frequently happens. Reviewing the cases and relevant researcheswas helpful to understand the disease and figure it out inultrasonic images.

Methods

Six cases of patients with uterine intravenous leiomyomatosis were reviewed which werehospitalized in Beijing Obstetrics and Gynecology Hospital during 2014 to 2016. All of the patients underwentultrasound examinations before surgery. The ultrasound findings,clinical presentations and pathological features of the 6 patients were evaluated.

Results

In 6 patients with uterine intravenous leiomyomatosis, 3 cases were solid tumors, located in the cervix region and para uterine region, withirregular veinvascular inside; 3 cases performance as multiple tumorlocated in dilated uterine vein, active tumor embolus were found in inferior vena cavain one of the 3 cases.

Conclusions

Uterine intravenous leiomyomatosisis found to be a solid mass located in the cervix region and para uterine region. The internal fissure of solid tumor is an important feature. Tumor extending to the iliac vein and inferior vena cava in some cases. Thusit is hard to be diagnosed before surgery by ultrasonography. Moreover, transvaginal ultrasound combined with inferior vena cava ultrasonography and echocardiography has a more obvious advantage in the diagnosis of the uterine intravenous leiomyomatosis.

Key words: Ultrasonography, Intravenous leiomyomatosis, Uterus

图9 患者45岁，术前超声诊断多发性子宫肌瘤，术中病理快速冰冻诊断为子宫IVL（静脉型），行紧急术中下腔静脉超声及超声心动图发现下腔静脉近心段活动性瘤栓，中等回声瘤栓依管状条索回声附着于下腔静脉内壁，随呼吸和血流方向改变摆动，术后病理诊断：静脉型IVL伴活动性瘤栓型IVL

图13~16 子宫IVL患者常规病理及免疫组化染色图。与图10~12同一患者，子宫切除术后病理镜检示肿瘤在子宫静脉内及子宫静脉周围生长（图13，HE ×16）；瘤细胞呈梭形，部分区域富于细胞，未见核分裂（图14 ，HE ×400）；免疫组化染色显示肿瘤周围内皮细胞CD31染色阳性（图15，CD31 ×50）；免疫组化染色显示肿瘤周边血管内皮细胞CD34染色呈阳性（图16，CD34 ×50），病理诊断：符合子宫IVL

1	Diakomanolis E, Elsheikh A, Sotiropoulou M, et al. Intravenous leiomyomatosis [J]. Arch Gynecol Obstet, 2003, 267(4): 256-257.
2	Pesi B, Moraldi L, Antonuzzo L, et al. Single-stage operation using hypothermic circulatory arrest to remove uterine intravenous leiomyomatosis extended to the vena cava and right atrium [J]. Int J Gynaecol Obstet, 2015, 129(1): 87-88.
3	Clement PB. Intravenous leiomyomatosis of the uterus [J]. Pathol Annu, 1988, 23(Pt 2): 153-183.
4	于昕，张国瑞，郎景和, 等. 子宫静脉血管平滑肌瘤病临床病例分析 [J]. 生殖医学杂志, 2016, 25(4): 295-299.
5	Norris HJ, Parmley T. Mesenchymal tumors of the uterus. V. Intravenous leiomyomatosis. A clinical and pathologic study of 14 cases [J]. Cancer, 1975, 36(6): 2164-2178.
6	Lu Z, Chen J. Introduction of WHO classification of tumours of female reproductive organs, fourth edition [J]. Zhonghua Bing Li Xue Za Zhi, 2014, 43(10): 649-650.
7	沈丹华，陈定宝. 解读第4版WHO女性生殖器官肿瘤分类中的变化 [J]. 中华妇产科杂志, 2014, 49(9): 717-720.
8	Ordulu Z, Nucci MR, Dal Cin P, et al. Intravenous leiomyomatosis: an unusual intermediate between benign and malignant uterine smooth muscle tumors [J]. Mod Pathol, 2016, 29(5): 500-510.
9	宋士秋，张健群，谢进生, 等. 右心系统子宫静脉平滑肌瘤病的诊断与外科治疗 [J]. 中华胸心血管外科杂志, 2012, 28(2): 76-78.
10	Kir G, Kir M, Gurbuz A, et al. Estrogen and progesterone expression of vessel walls with intravascular leiomyomatosis; discussion of histogenesis [J]. Eur J Gynaecol Oncol, 2004, 25(3): 362-366.
11	Nam MS, Jeon MJ, Kim YT, et al. Pelvic leiomyomatosis with intracaval and intracardiac extension: a case report and review of the literature [J]. Gynecol Oncol, 2003, 89(1): 175-180.
12	Dal Cin P, Quade BJ, Neskey DM, et al. Intravenous leiomyomatosis is characterized by a der(14)t(12;14)(q15;q24) [J]. Genes Chromosomes Cancer, 2003, 36(2): 205-206.
13	Clement PB, Young RH, Scully RE. Intravenous leiomyomatosis of the uterus. A clinicopathological analysis of 16 cases withunusual histologic features [J]. Am J Surg Pathol, 1988, 12(12): 932-945.
14	魏玲玲，张红安，郭晓慧, 等. 超声诊断下腔静脉至右心房血管平滑肌瘤一例 [J]. 中华医学超声杂志(电子版), 2008, 5(2): 62.
15	Nakai G, Maeda K, Yamamoto K, et al. Uterine Intravenous Leiomyomatosis with Cardiac Extension: Radiologic Assessment with Surgical and Pathologic Correlation [J]. Case Rep Obstet Gynecol, 2015, 2015: 576743.
16	Castelli P, Caronno R, Piffaretti G, et al. Intravenous uterine leiomyomatosis with right heart extension: successful two-stage surgical removal [J]. Ann Vasc Surg, 2006, 20(3): 405-407.
17	申剑. 伴心脏受累静脉内平滑肌瘤病的诊断与治疗进展 [J]. 中国胸心血管外科临床杂志, 2011, 18(3): 249-252.

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Diagnosis and differential diagnosis of uterine intravenous leiomyomatosis on sonography

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Diagnosis and differential diagnosis of uterine intravenous leiomyomatosis on sonography