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Abstract: The patient in this case is a 59-year-old woman who was found to have multiple fibroids in the uterus 6 years ago and was not reviewed regularly. Recently, she developed vaginal bleeding and visited a local hospital, where she was examined for a mass in the uterus, so she went to our hospital. After admission, the patient underwent other related tests and was suspected to have uterine sarcoma, so she underwent surgery and postoperative adjuvant chemotherapy. After treatment, the patient is doing well and is under continuous follow-up and treatment.
Basic information】Female, 59 years old
Disease Type】Uterine sarcoma
Hospital】Hunan Provincial Maternal and Child Health Hospital
Date of consultation】May 2022
Treatment plan】Surgery (tumor cytoreductive surgery) + drug treatment (injectable gemcitabine hydrochloride + docetaxel injection)
Treatment period】Surgery + chemotherapy, lifelong follow-up
Treatment effect】Surgery went well, no serious adverse effects of chemotherapy
I. Initial consultation
The patient complained that she was found to have multiple fibroids in the uterus 6 years ago in a local hospital physical examination (details unknown), but did not follow the doctor’s prescription for regular review, and had natural menopause in 2015. The patient was seen at a local hospital and had a complete hysterectomy. After 3 days, the symptoms recurred and the patient was re-admitted to the local hospital. The nature of the uterine mass was unclear on ultrasound examination (not shown on the list), and surgery was recommended. The gynecologic ultrasound showed that the uterus was unevenly enlarged, and the abnormal sound image was suspected of malignant tumor, and it was more likely to come from the cervix, suspected of uterine sarcoma, or cervical malignant tumor, so she was admitted to our department with menopausal vaginal bleeding and the cause to be investigated.
II. Treatment history
According to the patient’s condition, MRI examination was performed after admission, which indicated that the occupancy from the cervix to the uterine cavity was deep into the deep myometrium at the base of the uterus, and the lower edge was indistinctly demarcated from the myometrium of the posterior wall of the cervix, which was suspected to be a uterine sarcoma. After consideration, the patient’s family agreed to perform total hysterectomy + bilateral adnexal resection, intraoperative exploration, and tumor cytoreductive surgery if necessary. The operation went smoothly, and the excised tissues were sent for examination, suggesting high-grade endometrial mesenchymal sarcoma.
III. Treatment results
The patient’s surgery was successful, and the lesion was successfully removed without intraoperative hemorrhage and other complications, and her postoperative vital signs were stable and her mental status was good. After the operation, two follow-up visits and follow-up examinations were conducted, and the results of CT of the chest and abdomen and MRI of the pelvis were not abnormal for the time being, which indicated that the operation was effective and the condition had been initially controlled, and the patient was discharged after communication with the patient and his family.
IV. Notes
The patient’s family was very happy that the surgery was successful and the condition was initially controlled, and I was also infected by this emotion and felt happy for the success of the patient’s surgery, but the success of the surgery was only the first step of the treatment. In addition, we should pay attention to recuperation after surgery, and do not recommend prolonged exercise or heavy physical labor, but take a walk, play Tai Chi and other mild exercises, which can promote the recovery of the body to a certain extent.
V. Personal insight
High-grade endometrial mesenchymal sarcoma is an extremely rare and highly malignant tumor that lacks specific clinical manifestations. Therefore, once symptoms such as abnormal vaginal bleeding, uterine enlargement or pelvic masses occur, it is recommended to consult a doctor as soon as possible and to treat the suspected uterine sarcoma as soon as possible. In addition, the high-grade endometrial mesenchymal sarcoma diagnosed in the patient in this article requires active postoperative chemotherapy with the physician because of the late stage.