子宫癌肉瘤的超声表现与病理特征

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。

Ultrasonic and pathologic features of uterine carcinosarcoma

ObjectiveTo investigate the sonographic and histopathological features of uterine carcinosarcoma, so as to improve the understanding of the disease. MethodsSix 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. ResultsAll 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 (RIresistance 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. ConclusionUterine 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.