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患者女,47岁,生育一女。近2～3年来月经量增多,月经周期缩短,经期延长。此次因行经量多,伴剧烈腹痛急症入院.妇科检查子宫增大如孕3月大小,质地中等,双侧附件未触及明显肿块.妇科诊断:子宫肌瘤.B超检查子宫中位,明显增大,长14.0cm,宽9.0cm,厚7.5cm,内膜线居中,长9.0cm,厚1.85cm呈中等回声,宫腔内见-5.7Cmn×3.7Cm大小的实性光团回声,边缘清楚,欠光滑,其内部回声不均质,光团上部呈不规则片状强回声,并含有不规则小暗区,周围呈较弱回声,光团接近宫颈内口。B超诊断:子宫明显增大,子宫内膜癌可能。B超检查后一天患者阴道排出一巨大血凝块,复查B超,宫腔内光团消失,子宫体增大,内膜线增长增粗同前。手术所见子宫增大如孕3月大小,表面稍不平,但光滑无粘连双侧附件未见明显异常。病理诊断弥漫型子宫体内膜腺癌Ⅰ级,癌肿累及内膜层,局部病灶早期侵入浅肌层。讨论 子宫内膜癌发生在子宫体的内膜层,以腺癌为主,80%以上发生在50岁以上绝经前后妇女。临床表现为绝经后子
Female patient, 47 years old, has a baby. The past 2 to 3 years increased menstrual flow, shorten the menstrual cycle, menstrual prolongation. Due to the amount of exercise, with severe abdominal pain hospital admission gynecological examination of the uterus increased, such as size of pregnancy in March, medium texture, bilateral attachments did not touch the obvious mass.Gynecological diagnosis: uterine fibroids.B ultrasound examination in the uterus, significantly Increased, length 14.0cm, width 9.0cm, thickness 7.5cm, endometrial line center, length 9.0cm, thickness 1.85cm was moderate echo, uterine see -5.7Cmn × 3.7Cm size of the solid light echo group, the edge Clear, less smooth, the internal echo is not homogeneous, the upper part of the light group was irregular flake echo, and irregular small dark area around the weaker echo, light group near the mouth of the cervix. B-ultrasound: uterine significantly increased, endometrial cancer may be. One day after B ultrasound examination, a huge blood clot was excreted in the vagina of the patient, B ultrasound was rechecked, the intrauterine light mass disappeared, the uterus was enlarged, and the intima increased and thicken as before. Uterine surgery seen increased, such as size of pregnancy in March, the surface slightly uneven, but no adhesion of smooth bilateral attachment no obvious abnormalities. Pathological diagnosis of diffuse uterine endometrial adenocarcinoma Ⅰ, cancer involving the endometrial layer, local invasion of early shallow myometrial. Discussion Endometrial cancer occurs in the uterine endometrium, with adenocarcinoma, more than 80% occurred in women over the age of 50 before and after menopause. Clinical manifestations of menopause