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Abstract: The patient was found to have a uterine mass during physical examination for more than 1 year, but it was not treated for the time being because no uncomfortable symptoms were present. Six months ago, she was re-examined again at an outside hospital, suggesting the presence of hypoechoic nodules in the uterus, and was treated with medication with fair results. The abdominal pain then appeared, and after taking medication at the hospital, the symptoms were relieved, but for further improvement, she came to our hospital and was given surgery after perfecting the examination, and the intraoperative pathology was reported as uterine sarcoma.
Basic information】Female, 42 years old
Disease Type】Uterine sarcoma
Hospital】Hunan Provincial Maternal and Child Health Hospital
Date of consultation】April 2022
Treatment plan】Surgical treatment (uterine mass debulking, total hysterectomy + double adnexal resection) + medication (Letrozole tablets)
Treatment period】Hospitalization for 2 weeks, continuous follow-up
Effectiveness】Tumor removal, disease control
I. Initial consultation
The patient complained of a suspected uterine adenomyoma (details unknown) on ultrasound during a physical examination at an outside hospital in August 2020, but no special treatment was given because no uncomfortable symptoms occurred. The size of the mass did not change significantly compared with the previous one, so she was treated with Chinese herbal medicine again for 14 days at the outpatient clinic. The ultrasound showed a hypoechoic mass in the right wall of the uterus, the nature of which was to be determined (about 5 cm in diameter), and the pelvic MRI showed multiple uterine fibroids with partial degeneration. However, the patient went to our outpatient clinic for further consultation and treatment. A repeat ultrasound indicated suspected uterine fibroids (large tumor degeneration), so she was admitted to the outpatient clinic with the nature of the uterine mass to be investigated.
II. Treatment
According to the patient’s condition, the uterine fibroids were suspected to be degenerative and growing rapidly, accompanied by abdominal pain, and the possibility of malignancy could not be ruled out, so the patient was advised to undergo surgery to clarify the nature of the uterine mass. The patient returned to the ward safely after the operation. Because this tumor was hormone sensitive, postoperative adjuvant therapy with letrozole tablets was used to reduce the postoperative recurrence rate.
III. Treatment effect
The patient’s surgery was relatively smooth, the tumor did not show obvious extra-uterine invasion, and the pathological result was low-grade malignant tumor, so with the patient’s active cooperation, the body basically recovered 10 days after surgery and was discharged successfully after comprehensive evaluation. However, after discharge, long-term medication treatment was still required and follow-up visits were insisted. During the follow-up, there was no postoperative recurrence of malignant tumor, indicating that the treatment effect was good and the endometrial mesenchymal sarcoma had been controlled.
IV. Notes
The patient’s surgery was completed successfully and she recovered well after surgery. The patient was happy and I was also happy for her. However, the success of surgery is only the first step to overcome the disease. The patient needs to visit the outpatient clinic once every 3 months for 2-3 years after surgery, and then follow up every 6-12 months to detect whether there is any recurrence of tumor in time. In addition, it is still necessary to insist on taking medicine to reduce the recurrence rate of tumor after surgery. In daily life, with good personal protection, you can do exercise, such as yoga, swimming, etc., and pay attention to the regularity of work and rest, so as not to become physically weak, which will increase the probability of recurrence of endometrial mesenchymal sarcoma.
V. Personal insight
Low-grade endometrial mesenchymal sarcoma recurs late, on average 5 years after initial treatment. Patients should build up confidence in treating the disease, such as the patient in this case, and actively cooperate with doctors for treatment and proper daily care to control the aggravation in time. In addition, with regular follow-up, even if recurrence occurs after surgery, it can usually be controlled and the survival period after recurrence is higher than 5 years.