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中华医学超声杂志(电子版) ›› 2022, Vol. 19 ›› Issue (02) : 122 -127. doi: 10.3877/cma.j.issn.1672-6448.2022.02.005

妇产科超声影像学

子宫癌肉瘤的超声表现与病理特征
李杨1, 张丹1,(), 李燕东2   
  1. 1. 100038 北京,首都医科大学附属复兴医院超声影像科
    2. 100038 北京,首都医科大学附属复兴医院超声影像科病理实验室
  • 收稿日期:2021-03-25 出版日期:2022-02-01
  • 通信作者: 张丹

Ultrasonic and pathologic features of uterine carcinosarcoma

Yang Li1, Dan Zhang1,(), Yandong Li2   

  1. 1. Department of Ultrasound, Fuxing Hospital, the Eighth Clinical Medical College, Capital Medical University, Beijing 100038, China
    2. Pathology Laboratory, Fuxing Hospital, the Eighth Clinical Medical College, Capital Medical University, Beijing 100038, China
  • Received:2021-03-25 Published:2022-02-01
  • Corresponding author: Dan Zhang
引用本文:

李杨, 张丹, 李燕东. 子宫癌肉瘤的超声表现与病理特征[J/OL]. 中华医学超声杂志(电子版), 2022, 19(02): 122-127.

Yang Li, Dan Zhang, Yandong Li. Ultrasonic and pathologic features of uterine carcinosarcoma[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(02): 122-127.

目的

分析子宫癌肉瘤的超声声像图表现及病理组织学特点,提高对本病的认识。

方法

回顾性收集2009年1月至2018年12月首都医科大学附属复兴医院收治并经病理证实的6例子宫癌肉瘤患者的临床资料,分析其超声声像图表现与病理组织学特点。

结果

6例子宫癌肉瘤患者均为绝经后女性,临床表现为绝经后不同程度的阴道出血。超声表现:绝经后子宫测值增大,6例患者子宫三径之和132~248 mm,平均(199.7±36.8)mm,宫腔回声明显增厚呈息肉样,内呈不均质中高或中低回声,最大径14~81 mm,最大径平均值(47.2±21.3)mm;肿瘤部分边界清晰,可见“亮边”,形态欠规则,部分与肌层分界不清;血流评分3例4分,2例3分,1例2分,均可测及动脉血流频谱(阻力指数:0.15~0.59)。病理检查:3例为中分化子宫癌肉瘤,3例为低分化子宫癌肉瘤;镜下病理见瘤体内血管丰富;6例均伴有肌层浸润。

结论

子宫癌肉瘤多表现为绝经后阴道出血伴体积较大的息肉样病变,基底部粗大的供养血管多提示肌层浸润,宫腔镜检查可获得病理诊断。

Objective

To investigate the sonographic and histopathological features of uterine carcinosarcoma, so as to improve the understanding of the disease.

Methods

Six cases of uterine endometrial carcinosarcoma confirmed by pathology at Fuxing Hospital, the Eighth Clinical Medical College, Capital Medical University from January 2009 to December 2018 were retrospectively analyzed.

Results

All the six patients with uterine carcinosarcoma were postmenopausal women. The clinical manifestation was postmenopausal vaginal bleeding of different degrees. Ultrasonographic examination showed that the uterus increased in postmenopausal women. The sum of the three uterine diameters of the six patients was 132-248 mm, with an average of (199.7±36.8) mm. The echo of the uterine cavity was obviously thickened and polypoid, with heterogeneous medium high or low echo in the uterus. The maximum diameter was 14-81mm, with an average of (47.2±21.3) mm. The boundary of some tumors was clear, with a "bright edge" and irregular shape. The boundary between some tumors and the myometrium was not clear. The blood flow score was 4 points in three cases, 3 points in two, and 2 points in one. The arterial blood flow spectrum could be obtained in all cases (RI[resistance index]: 0.15-0.59). Pathological examination revealed three cases of moderately differentiated endometrial carcinosarcoma and three cases of poorly differentiated endometrial carcinosarcoma. Microscopic pathology showed abundant blood vessels in the tumor, and six cases were accompanied by myometrial invasion.

Conclusion

Uterine carcinosarcoma is mostly manifested as postmenopausal vaginal bleeding with large polypoid lesions. The presence of large supporting vessels at the base of the uterus often indicate myometrial invasion. Hysteroscopy can help achieve a pathological diagnosis.

图1 患者,74岁,常规超声显示宫腔内肿瘤,瘤体形态饱满,前缘可见“亮边”,后缘部分区域与肌层界限不清,瘤体最大径54 mm 图2 患者,54岁,常规超声示宫腔内息肉样病变,呈较均质的中高回声,后缘可见“亮边”,瘤体最大径35 mm
图3 患者,74岁,彩色多普勒血流显像示宫腔内肿瘤,瘤体血流信号丰富,血流信号自两侧壁穿入瘤体,血流评分4分 图4 患者,54岁,彩色多普勒血流显像示血流信号自前壁穿入瘤体,血流评分3分
图5 患者,74岁,频谱多普勒超声示瘤体核心部位的低阻力动脉血流,阻力指数:0.15 图6 患者,54岁,频谱多普勒超声示瘤体主干部位血流阻力高于瘤体核心部位,阻力指数:0.48
图7 患者,62岁,宫腔镜检查示病变呈息肉样,充满宫腔,瘤体表面可见粗大血管
图8 患者,65岁,镜下病理示恶性上皮成分癌与恶性间叶成分肉瘤交界(HE ×100),病理诊断为中分化子宫癌肉瘤 图9 患者,74岁,镜下病理见子宫癌肉瘤瘤体内密集分布的血管结构(HE ×40)图10 患者,62岁,镜下病理示子宫癌肉瘤瘤体呈树根样插入肌层(HE ×100)
表1 6例子宫癌肉瘤患者临床、超声表现及病理特征
图11 患者,62岁,镜下病理可见正常萎缩子宫内膜与子宫癌肉瘤隆起样瘤体的交界部(黑色箭头为隆起的肿瘤组织,白色箭头为萎缩的正常子宫内膜;HE ×40)图12 患者,74岁,镜下病理见子宫癌肉瘤瘤体表面光滑(HE ×40)
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