摘要
目的总结血管内平滑肌瘤病的影像学特点及临床治疗经验。方法回顾性分析我院2014年1月至2019年12月确诊的5例血管内平滑肌瘤病患者的临床表现、影像学资料、手术治疗情况及术后病理和免疫组织化学染色等资料,总结血管内平滑肌瘤病的影像学特点及临床治疗经验。结果5例患者均为女性,年龄为46~60岁(平均51.8岁),均有子宫肌瘤病史,其中2例有子宫及双侧附件全切除术史。2例患者平滑肌瘤侵及右心房,表现为心功能受损症状,余3例分别以右下肢肿胀不适、腹部肿块、下腹胀就诊。4例患者行超声及下腔静脉CT造影检查,2例行盆腔或腹部MRI平扫+增强检查,1例行血管造影检查。5例患者均行血管平滑肌瘤切除+血管成形术。2例病灶累及右心房的患者中,1例患者行一期手术治疗,1例行二期手术,术后均恢复良好。1例患者因术后4年复发再次手术。1例患者因术中出血较多,未切除右侧髂总静脉内肿瘤,行肿瘤大部切除+髂总静脉起始端结扎术。5例患者的免疫组织化学染色均表现为平滑肌肌动蛋白(SMA)(+)、钙调理蛋白(CALP)(+)、抑癌基因P53(-)、CD31(-)、细胞增殖相关抗原Ki-67(-);仅1例患者雌激素受体(ER)、孕激素受体(PR)均为阳性,1例ER、PR均为部分阳性,1例为ER部分阳性、PR少量阳性,2例患者未见ER、PR染色相关资料。5例患者术后均定期复查,随访至2021年2月均未见复发。结论血管内平滑肌瘤病无特异性临床表现,但影像学检查特征明确,结合临床表现及妇科病史可提高诊断准确性。
Objective To summarize the imaging features and clinical treatment experience of intravascular leiomyomatosis.Methods The clinical manifestations,imaging data,surgical treatment,postoperative pathology and immunohistochemical staining of 5 patients with intravascular leiomyomatosis diagnosed in our hospital from Jan.2014 to Dec.2019 were retrospectively analyzed,and the imaging features and clinical treatment experience were summarized.Results The 5 patients were all females,with an average age of 51.8 years(ranged 46-60 years),and all had a history of hysteromyoma,and 2 of them had a history of hysterectomy and bilateral adnexectomy.Two cases presented with leiomyoma invading the right atrium,showing symptoms of impaired cardiac function;the remaining 3 cases presented with right lower limb swelling,abdominal masses,and lower abdominal distension.Four cases underwent ultrasound and computed tomography(CT)angiography of the inferior vena cava,2 cases underwent magnetic resonance imaging(MRI)plain scan+enhanced examination,and 1 case underwent angiography.All patients underwent angiomyoma resection+angioplasty.Of the 2 cases presented with leiomyoma invading the right atrium,1 case underwent primary surgery,1 case underwent secondary surgery,and both patients recovered well after surgery.One case was re-operated due to recurrence 4 years after surgery.One case underwent a major resection of the tumor+ligation of the common iliac vein due to excessive bleeding during the operation,and the tumor in right common iliac vein was not resected.In the 5 cases,the common features of immunohistochemical staining were smooth muscle actin(SMA)(+),calponin(CALP)(+),P53(-),CD31(-),Ki-67(-);only 1 case was positive for estrogen receptor(ER)and progesterone receptor(PR),1 case was partially positive for both ER and PR,1 case was partially positive for ER and slightly positive for PR,and 2 cases had no ER or PR staining data.All the 5 patients were followed up regularly and no recurrence was found until Feb.2021.Conclusion The cli
作者
钟婧娇
宋涛
衣月玲
ZHONG Jing-jiao;SONG Tao;YI Yue-ling(Department of Radiology,Changhai Hospital,Naval Medical University(Second Military Medical University),Shanghai 200433,China;Department of Emergency,Changhai Hospital,Naval Medical University(Second Military Medical University),Shanghai 200433,China)
出处
《第二军医大学学报》
CAS
CSCD
北大核心
2021年第7期811-817,共7页
Academic Journal of Second Military Medical University
关键词
平滑肌瘤
子宫肿瘤
血管肌瘤
血管内肿瘤
leiomyoma
uterine neoplasms
angiomyoma
intravascular neoplasms
