少女阔韧带恶性苗勒氏混合瘤 1例并文献复习(2)
生殖系统以外MMMT原则上一经明确诊断，应即行手术治疗，降低肿瘤负荷，缓解症状，术后辅以放疗或化疗[9]。孕激素受体阳性者孕激素治疗可能有效。研究发现生殖系统外MMMT早期即可转移，预后差，术后平均存活时间为14个月[10]。这可能与其自身的生物学行为特征以及宫外的位置更易超出盆腹腔有关。影响预后的最重要的因素取决于肿瘤中癌细胞恶性度的高低，而不是间质的肉瘤成分。该病人二次手术时已发生广泛转移，可见生殖系统外MMMT恶性程度高，病情发展迅速。该病人进行了较理想的恶性肿瘤细胞减灭术加术后TP方案化疗，现暂无复发迹象，但远期疗效尚有待于进一步观察。在今后的临床工作中应引以为戒，提高对生殖系统外MMMT的认识，尽量减少误诊。
参考文献：
[1] Jonson AL, Bliss RL, Truskinovsky A, et al. Clinical features and outcomes of uterine and ovarian carcinosarcoma. Gynecol Oncol 2006;100:561～4.
, http://www.100md.com
[2] Hudelist G, Unterrieder K, Kandolf O, et al. Malignant mixed Müllerian tumor with heterologous component arising in the fallopian tube--a case report. Eur J Gynaecol Oncol. 2006;27(5):509～12.
[3]Sebenik M, Yan Z, Khalbuss WE, et al. Malignant mixed mullerian tumor of the vagina: case report with review of the literature, immunohistochemical study, and evaluation for human papilloma virus. Hum Pathol. 2007;38(8):1282～8.
[4] Kato N, Motoyama T. Ascitic fluid cytology of a malignant mixed Müllerian tumor of the peritoneum: a report of two cases with special reference to p53 status. Diagn Cytopathol. 2009;37(4):281～5.
, 百拇医药
[5] Wei L, Wang J, Zhang X, et al. Primary omental malignant mixed müllerian tumor in a 67-year-old woman. Chin Med J (Engl). 2002;115(1):138～40.
[6]李 杨，陈 玲，苏克平.阔韧带恶性Mü11erian混合瘤 1例[J].实用妇产科杂志，2008，24(1)，59.
[7] Mikami M, Kuwabara Y, Tanaka K, et al. Malignant mixed müllerian tumor of primary mesenteric origin. Int J Gynecol Cancer. 2005;15(6):1249～53.
[8]常玉青. 阔韧带肿瘤13例临床分析[J]. 临床医学，1996，16(2)：25.
, http://www.100md.com
[9] Ko ML, Jeng CJ, Huang SH, et al. Primary peritoneal carcinosarcoma (malignant mixed mullerian tumor): Report of a case with five-year disease free survival after surgery and chemoradiation and a review of literature. Acta Oncol. 2005;44(7):756～60.
[10]Garamvoelgyi E, Guillou L, Gebhard S, et al. Primary malignant mixed Müllerian tumor (metaplastic carcinoma) of the female peritoneum. A clinical, pathologic, and immunohistochemical study of three cases and a review of the literature. Cancer. 1994, 1;74(3):854～63.
作者简介：
贺伟华 (1982-2)，浙江大学医学院妇产科专业，硕士，住院医师，妇科肿瘤方向。
通讯作者：
夏雅仙, 百拇医药(贺伟华 张秀明 夏雅仙)
参考文献：
[1] Jonson AL, Bliss RL, Truskinovsky A, et al. Clinical features and outcomes of uterine and ovarian carcinosarcoma. Gynecol Oncol 2006;100:561～4.
, http://www.100md.com
[2] Hudelist G, Unterrieder K, Kandolf O, et al. Malignant mixed Müllerian tumor with heterologous component arising in the fallopian tube--a case report. Eur J Gynaecol Oncol. 2006;27(5):509～12.
[3]Sebenik M, Yan Z, Khalbuss WE, et al. Malignant mixed mullerian tumor of the vagina: case report with review of the literature, immunohistochemical study, and evaluation for human papilloma virus. Hum Pathol. 2007;38(8):1282～8.
[4] Kato N, Motoyama T. Ascitic fluid cytology of a malignant mixed Müllerian tumor of the peritoneum: a report of two cases with special reference to p53 status. Diagn Cytopathol. 2009;37(4):281～5.
, 百拇医药
[5] Wei L, Wang J, Zhang X, et al. Primary omental malignant mixed müllerian tumor in a 67-year-old woman. Chin Med J (Engl). 2002;115(1):138～40.
[6]李 杨，陈 玲，苏克平.阔韧带恶性Mü11erian混合瘤 1例[J].实用妇产科杂志，2008，24(1)，59.
[7] Mikami M, Kuwabara Y, Tanaka K, et al. Malignant mixed müllerian tumor of primary mesenteric origin. Int J Gynecol Cancer. 2005;15(6):1249～53.
[8]常玉青. 阔韧带肿瘤13例临床分析[J]. 临床医学，1996，16(2)：25.
, http://www.100md.com
[9] Ko ML, Jeng CJ, Huang SH, et al. Primary peritoneal carcinosarcoma (malignant mixed mullerian tumor): Report of a case with five-year disease free survival after surgery and chemoradiation and a review of literature. Acta Oncol. 2005;44(7):756～60.
[10]Garamvoelgyi E, Guillou L, Gebhard S, et al. Primary malignant mixed Müllerian tumor (metaplastic carcinoma) of the female peritoneum. A clinical, pathologic, and immunohistochemical study of three cases and a review of the literature. Cancer. 1994, 1;74(3):854～63.
作者简介：
贺伟华 (1982-2)，浙江大学医学院妇产科专业，硕士，住院医师，妇科肿瘤方向。
通讯作者：
夏雅仙, 百拇医药(贺伟华 张秀明 夏雅仙)