Clinical characteristics and diagnosis and treatment analysis of 32 cases of malignant uterine tumors confirmed by postoperative pathology of"uterine fibroids"
Objective To analyze the clinical data of patients with uterine malignant tumors who were misdiagnosed as uterine fibroids before surgery,and to summarize the experience in order to improve the preoperative diagnostic rate.Methods Retrospective analysis of clinical data of 32 patients admitted to Beijing Obstetrics and Gynecology Hospital,Capital Medical University from January 2018 to December 2023 who underwent surgical treatment for uterine fibroids and were found to have uterine malignant tumors during or after surgery.Results The average age of onset of 32 patients was(50.6±7.6)years old,16 cases(50.00％)had abnormal uterine bleeding,6 cases(18.75％)had compression symptoms such as frequent urination and constipation,2 cases(6.25％)had palpable lower abdominal masses,and 8 cases(25.00％)had uterine fibroids during physical examination;the average course of disease was(16±5)months.The average maximum nodule was(10.5±4.5)cm.The main ultrasound manifestation was a solid mass with enlarged uterus and uneven echogenicity,sometimes with irregular cystic areas,abundant blood flow around or inside the mass.The MRI indicates that T1 showed equal signal,T2 showed high signal,and the enhanced scan showed obvious uneven enhancement with unclear boundaries.Postoperative pathology showed 12 cases of uterine leiomyosarcoma,2 cases of epithelioid leiomyosarcoma,11 cases of endometrial stromal sarcoma,5 cases of adenosarcoma,1 case of carcinosarcoma,and 1 case of malignant stromal tumor.32 patients underwent surgical treatment for"uterine fibroids",including 12 cases of myomectomy,20 cases of total hysterectomy,14 cases of secondary supplementary surgery,and 1 case of postoperative adjuvant radiotherapy or chemotherapy.There were 2 cases of postoperative recurrence and no deaths as of May 2024.Conclusions The malignant tumor of the uterus misdiagnosed as uterine fibroids before surgery is mainly uterine sarcoma.It is difficult to make a clear diagnosis before surgery.If the patient has symptoms of abnormal uterine bleeding,endometrial biopsy is required.For postmenopausal patients,patients with high risk factors for malignant tumors,preoperative ultrasound or nuclear magnetic resonance suggesting that the tumor echo is uneven,the boundary is unclear,and the blood supply is abundant should be vigilant.If necessary,the radiologists should consult and read the film again,and the surgical methods and approaches should be carefully selected.The specimens should be carefully dissected and sent to the frozen pathological examination in time.
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