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目的:探讨Müllerian腺肉瘤(MA)的临床与超声特点。方法:回顾性分析复旦大学附属妇产科医院2007年11月至2014年7月25例经手术病理检查证实为MA患者的临床病史及超声表现。结果:125例MA患者平均年龄48.2±13.8岁,10例为绝经后妇女。主要临床表现为异常阴道流血(22例),下腹痛(1例)及体检发现异常占位(2例)。病变部位在子宫内膜20例(80%)、宫颈3例(12%)、宫腔和宫颈1例(4%)以及盆腔内1例(4%)。16例单纯MA,5例伴性索样分化,4例伴肉瘤成分过度生长。其FIGO分期为ⅠA 8例、ⅠB 14例、ⅠC 1例,ⅢA 1例。2MA位于子宫的患者超声图像显示宫腔或(及)颈管内单个大小不等(最大径12~95mm,平均40.1±24.5mm)的息肉样占位,部分脱垂到阴道内(24例);形态不规则,边界模糊(8例)或尚清晰(16例);实性为主者22例(88%),囊实性者2例(8%),而1例(4%)位于盆腔内者是囊性为主、边界不清的低回声肿块。彩色多普勒血流显像:条索状血流信号7例,星点状血流信号者12例,彩色血流信号不明显者6例。结论:MA是一种少见的低度恶性肿瘤,其临床及超声表现无特异性,需要病理检查确诊。熟悉其临床及超声表现有助于加强对MA的认识,从而正确诊断。
Objective: To investigate the clinical and ultrasonic features of Müllerian adenosarcoma (MA). Methods: A retrospective analysis of Fudan University Obstetrics and Gynecology Hospital from November 2007 to July 2014 25 cases confirmed by pathological examination of MA patients with clinical history and ultrasound findings. Results: The average age of 125 patients with MA was 48.2 ± 13.8 years and 10 were postmenopausal women. The main clinical manifestations of abnormal vaginal bleeding (22 cases), lower abdominal pain (1 case) and physical examination found abnormal occupancy (2 cases). Lesions in the endometrium in 20 cases (80%), 3 cases of cervical (12%), uterus and cervix in 1 case (4%) and pelvic in 1 case (4%). 16 cases of simple MA, 5 cases of cord-like cord differentiation, 4 cases of sarcoma with excessive growth. The FIGO staging of Ⅰ A 8 cases, Ⅰ B 14 cases, Ⅰ C 1 cases, Ⅲ A 1 cases. Ultrasound images of patients with 2MA located in the uterus showed polyposis in the uterine cavity or in the cervical canal with a single size ranging from 12 to 95 mm in diameter (average 40.1 ± 24.5 mm), and some of them were prolapsed into the vagina (24 cases). (8 cases) or clear (16 cases); 22 cases (88%) were real, 22 cases (8%) were cystic and 1 case (4%) were located in pelvic The inside is cystic, the boundary of the hypoechoic mass. Color Doppler flow imaging: cord blood flow signal in 7 cases, 12 cases of star-like blood flow signal, 6 cases of color blood flow signal was not obvious. Conclusion: MA is a rare low-grade malignancy. Its clinical and ultrasonographic features are non-specific and require pathological examination. Being familiar with their clinical and ultrasonographic findings helps to increase awareness of MA and thus correct diagnosis.