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患者,女,18岁.发现鸡蛋大下腹肿物1年,无不适未诊治.近3个月肿物增长快,经期延长,且经血增多有血块.下腹隐痛、尿频、肛门坠胀感.于1992年3月4日入院.检查:下腹可及肿瘤质硬、不活动.阴道有少量血液,宫颈表面光滑,肥大.子宫如孕4个月大小,质硬,活动差.双附件增厚.B超示子宫增大,诊断子宫肌瘤.入院诊断:①子宫肌瘤变性,②子宫肌腺症,③子宫内膜癌.诊刮病理:考虑子宫内膜间质肉瘤.开腹探查:子宫均匀增大,表面光滑.右侧卵巢增大表面有小结节.左附件正常.大网膜、肠系膜、脾及膀胱表面有多数米粒到蚕豆大瘤结节,质硬.宫颈粗大固定.行子宫次全、双侧附件及部分大网膜切除术.病理检查:次全子宫13cm×12cm×11cm,弥漫增大,肌壁厚4cm～6.8cm,宫颈残端直径6cm.多切面切开见散在米粒大、绿豆大颗粒状或条索状牙膏样突起,质地脆嫩.内膜面粗糙出血,局部呈灰黄色息肉状突起.右侧卵巢5.5cm×3.5cm×2.8cm,表面及切面是结节状灰白色,质细腻.左卵巢正常.大网膜切面亦见米粒到蚕豆大多个灰白色质嫩瘤结节.镜下:瘤细胞呈梭形或卵圆形,胞浆淡染,边界不清楚.核呈空泡状椭圆形或不规则,异形明显,可见
Patients, female, 18 years old. Found that the eggs of the lower abdomen tumor for 1 year, no discomfort without diagnosis and treatment. Nearly 3 months, rapid growth of the tumor, menstrual extension, and increased blood clots. Abdominal pain, frequent urination, anal bulge. March 4, 1992 admitted to the hospital.Check: lower abdomen and tumor hard, not active.Vaginal a small amount of blood, cervical surface smooth, hypertrophy.Uterine, such as pregnancy 4 months size, hard, poor activity .Double attachment thickened. B ultrasound shows the uterus increases, the diagnosis of uterine fibroids. Admission diagnosis: ① uterine fibroids degeneration, ② adenomyosis, ③ endometrial cancer. Scraping pathology: consider endometrial stromal sarcoma. Open exploration: the uterus Uniform increase, the surface is smooth .On the right side of the ovary increased nodules on the surface .Luo attachment normal .Oily omentum, mesentery, spleen and bladder surface most of the rice to the broad bean nodules, hard .Large thick fixed. Uterine subtotal, bilateral attachment and partial omental resection.Pathological examination: the second full uterus 13cm × 12cm × 11cm, diffuse increased, muscle wall thickness 4cm ~ 6.8cm, cervical stump diameter 6cm. Scattered in the rice grain, mung bean large granular or cord-like toothpaste-like protrusions, texture crisp endometrial rough bleeding, local gray-yellow Meatal process.The right ovary 5.5cm × 3.5cm × 2.8cm, the surface and the section is nodular gray, fine quality.Love the ovary normal.The omentum section also see the grain to the broad bean nodules many gray nodules. Microscope: Tumor cells were fusiform or oval, light cytoplasm, the border is not clear.The nucleus was vacuolar oval or irregular, obvious shape, visible