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Abstract: A 44-year-old female patient presented with uterine fibroids for 7 years with menstrual disorders and heavy menstrual flow. After a series of preliminary gynecologic examinations, the fibroids were suspected to be malignant and further pathologically diagnosed as uterine smooth muscle sarcoma.
Basic information】Female, 44 years old
Disease Type】Uterine smooth muscle sarcoma
Hospital】Guangzhou Huadu District People’s Hospital
Date of consultation】April 2019
Treatment plan】Surgical treatment (exploratory dissection surgery, bilateral adnexa, part of the greater omentum and pelvic abdominal aorta lymph node removal) + chemotherapy drugs (cisplatin injection) + intravenous injection (ornidazole injection, levofloxacin injection, sodium chloride glucose injection)
Treatment cycle] 10 days of hospitalization, 6 courses of intermittent chemotherapy, regular review
Treatment effect] All indexes have returned to normal and reached the state of healing
I. Initial consultation
The woman has been suffering from uterine fibroids for 7 years, with menstrual disorders, increased menstrual flow and irregular vaginal bleeding for 2 years, and the clinical effect of oral herbal treatment was not obvious (specific drugs are not known). The bleeding decreased but still did not stop, so she came to our hospital for treatment.
Physical examination: the patient’s body temperature was 36.8℃, heart rate 88 times/min, respiration 20 times/min, blood pressure 116/68mmHg, anemic appearance, slightly pale lips and eyelids, no abnormality in cardiopulmonary auscultation, flat and soft upper abdomen, liver and spleen were not palpable, a mass was palpable on the pubic symphysis in the lower abdomen, about 10×9×8cm, with an uneven surface, but no obvious pressure pain. Gynecological examination: the patient had normal vulvar development, blood staining, dark red blood discharge in the vagina, no ulcers and superfluous organisms in the vaginal mucosa, smooth cervix, anterior uterus about 10×9×8 cm in size, uneven surface, hard, normal activity, no abnormality in both adnexal areas.
Vaginal ultrasound examination: the uterus was enlarged, with abnormal morphology. A type of circular mixed echogenic mass with poorly defined borders was seen in the posterior myometrium, with predominantly hypoechoic, scattered strongly echogenic spots and liquid areas with heterogeneous distribution, and rich internal and peripheral blood flow signals. The endometrial pressure was not clear. The diagnosis suggested a mixed echogenic mass in the posterior wall of the uterus, myoma degeneration, and sarcoma.
II. Treatment history
The patient was admitted to the hospital and recommended for surgical treatment. After the family and the patient signed the consent, an exploratory dissection was performed under epidural anesthesia, during which the enlarged surface of the uterus was seen to be uneven, and the uterus was excised for frozen pathological section.
Therefore, the patient’s bilateral adnexa, part of the greater omentum and the pelvic abdominal aortic lymph nodes were removed. After surgery, the patient was given ornidazole injection and levofloxacin injection to prevent infection and glucose sodium chloride injection for rehydration treatment. The stitches were removed 7 days after surgery, the wound healed in one stage, and the patient was discharged from the hospital 10 days after surgery. One month after the patient’s discharge, the patient’s surgical incision was basically healed and he returned to the hospital for chemotherapy with cisplatin injection for a total of 6 courses.
The chemotherapy process was painful, and the patient experienced severe nausea, vomiting, anorexia, fatigue, dizziness, and hair loss, which caused a lot of mental stress to the patient. Therefore, during chemotherapy, in order to reduce the toxicity of the drug to the kidneys, the patient underwent intravenous sodium chloride injection with glucose to replenish body fluids.
III. Treatment effect
After surgery and postoperative chemotherapy, the patient’s vaginal bleeding symptoms disappeared, the lower abdominal mass disappeared, the indicators of gynecological tumor markers have returned to normal, no abnormality was seen in the pelvis by ultrasound examination, the patient’s general condition was good, no anemic appearance, and the hematocrit returned to normal by routine blood examination. Six months after the operation, the patient resumed normal work and was advised to insist on regular gynecological examination.
IV. Precautions
I am glad that the patient’s condition has improved, but uterine smooth muscle sarcoma is one of the malignant tumors in gynecology, and there is still a possibility of recurrence despite surgical treatment. Therefore, we suggest that the patient should pay attention to regular follow-up after discharge from the hospital, and do ultrasound examination once every six months to understand the situation in the pelvis, observe whether the inguinal lymph nodes are enlarged, and observe the color and nature of vaginal secretions. In addition, it is important to weigh regularly. Once there is a continuous weight loss or uncomfortable symptoms such as dizziness, weakness and wasting, you should follow up and seek medical attention at any time.
V. Personal insight
In this case, the patient’s uterine fibroids became malignant and formed uterine smooth muscle sarcoma. Therefore, for patients with uterine fibroids without surgical indications, regular checkups and laboratory tests for gynecological tumor markers should be done to help prevent tumor recurrence. Although the rate of malignant transformation of uterine fibroids is less than 2%, but as long as there is a possibility of malignant transformation, it must be paid attention to, during the regular checkups, the growth rate is accelerated or the gynecological tumor markers are abnormal, it is recommended to operate as soon as possible, once malignant transformation occurs, it not only brings great mental and physical pain to the patient, but also decreases the quality of life and even shortens the life of the patient.