| Objective:To study the epidemiology,common clinical feature and the imaging findings of sarcoma of uterus,provide clinical basis for better diagnosis and treatment of uterine sarcoma.To analyze the incidence rate and the clinical manifestation of unexpected uterine sarcoma for the prevention of the disease and the bad prognosis which the disease result in.Method:1.We collected 66 cases of uterine sarcoma diagnosed by pathology after surgery in Tianjin central hospital of gynecology obstetrics from May 2011 to May 2016.SPSS19.0 was used to analyze the clinical features including patients' age,menopause,reproductive history,the size of mass,clinical staging,tumor maker and the expression of ER,PR and Ki-67,also imaging findings and prognosis were analyzed by the software.X2 test was used for enumeration data.When a cell data count is small,use the Fisher exact test.The Kaplan-Meier product limit method was used to analyze the survival curve.The log-rank test was used to analyze the prognostic factors of the patients.The multivariate analysis of prognosis was performed by COX regression model.2.From May 2011 to July 2016,we summarized the number of uterine fibroid in total of 6710 cases in our hospital,and 45 cases of uterine sarcoma who diagnosed by pathology after operation.We analyzed incidence rate and clinical feature of unexpected uterine sarcoma from the data by using X2 test in enumeration data.We read amount of Chinese and English paper to study the unexpected uterine sarcoma which needs second operation,the influence of morcellation to prognosis of uterine sarcoma and how to prevent the unexpected uterine sarcoma and how to avoid the bad influence resulted in unexpected uterine sarcoma.Result:1.Constitution ratio: Uterine sarcoma accounted for 4.7% of uterine malignancies,there are 28 cases of LMS,25 cases of ESS and 13 cases of AS in 66 cases of uterine sarcoma.And the majority histologic type are LMS and ESS.2.Age: the youngest age is 24 years old and the oldest age is 68 years old and 47.83±8.42 is the average age and the median age is 49 years.The age of uterine leiomyosarcoma is older than that of endometrial stromal sarcoma(50.61±7.85 VS 45.36±7.85 P=0.008).3.Menopause and Fertility history: More than half of cases of pre-menopause developed the disease,the vast majority of patients developed with fertility,the menopausal state and the fertility history among the different histologic types were not different statistically.4.Clinical features and Clinical staging: The clinical stage of the patient is predominantly in stage I,the most common clinical manifestations of irregular vaginal bleeding.There were no statistically significant differences in clinical manifestations and clinical staging of patients with different histological types.5.History and size of tumor: The longest history of up to 20 years,the shortest 1 month,the size of the tumor from 2.5 to 25 cm,There were statistically significant differences in the history and size of the tumor between the organizations(P=0.033 P=0.033).6.Preoperative examination:There was no significant difference in CA125 positive between the organizations.Adenosarcoma preoperative uterine curettage positive rate is higher(P=0.001).MRI diagnosis of uterine sarcoma as 68.18%,better than gynecological ultrasound(P = 0.000).7.Expression of ER / PR receptor and Ki-67: The expression of ER / PR in the tissues was statistically significant(P=0.042),and the ER/PR were highly expressed in endometrial stromal sarcoma.There was no significant difference in Ki-67 expression between tissues.8.Prognosis:In the univariate analysis,age,the clinical stage,rvascularized tumor thrombus is a related factor in the prognosis of patients.(P=0.042 P=0.002 P=0.003)The multivariate analysis of clinical stage,vascular tumor thrombus is an independent factor affecting the prognosis of patients(P=0.014 P=0..008),ER/PR Positive expression,pathological type,treatment of patients with no significant difference in prognosis.9.The incidence of unexpect uterine sarcoma was not expected to be 6.7 ‰,mainly in early patients,mainly uterine leiomyosarcoma,followed by endometrial stromal sarcoma,adenosarcoma rare.10.The age of onset of unexpect uterine sarcoma was 46.51 ± 8.14 years old,the average history of fibroids was 2.89 ± 1.79 years,the number of fibroids ? 3;the age of uterine fibroids was 41.98 ± 0.34 years old,the history of fibroids was 4.32 ± 2.28 years(P = 0.039 P = 0.033 P = 0.003).There was no significant difference in the clinical manifestations and menopausal status between the two groups.There was no significant difference between the two groups(P> 0.05).11.Unexpect uterine sarcoma and uterine fibroids between the signs of ultrasonography were statistically significant(P <0.05),uterine fibroids showed clear boundary ultrasound,echo to the main low echo,the internal blood flow distribution rules,but not expected uterine sarcoma patients Border clear,echo to honeycomb or high echo-based,uneven blood flow distribution.Conclusion:1.The incidence of uterine sarcoma accounted for 4.7% of uterine malignancies,mostly in premenopausal women,no specific clinical manifestations,the most common clinical manifestations is irregular vaginal bleeding.2.Uterine sarcoma without specific ultrasound image,and lack of special tumor markers,preoperative diagnostic curettage or hysteroscopy examination can improve the uterine sarcoma preoperative diagnosis rate.MRI is superior to gynecological ultrasonography in the diagnosis of uterine sarcoma3.In the univariate analysis,age,the clinical stage,vascularized tumor thrombus is a related factor in the prognosis of patients.The multivariate analysis of clinical stage,vascular tumor thrombus is an independent factor affecting the prognosis of patients,ER/PR Positive expression,pathological type,treatment of patients with no significant difference in prognosis.4.The incidence of uterine sarcoma was not expected to be 6.7 ‰,mainly in early patients,mainly uterine leiomyosarcoma,followed by endometrial stromal sarcoma,adenosarcoma rare.5.Unexpected uterine sarcoma and uterine fibroids compared to patients with compared with the age of onset,fibroids history is short,few features of fibroids.There was no significant difference in menopausal status and clinical manifestations between the two groups.6.Uterine fibroids showed a clear boundary of ultrasound,echo to low echo-based,tumor blood flow distribution rules,and not expected uterine sarcoma patients border clear,echo to honeycomb or high echo-based,uneven blood flow distribution. |
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