Unusual Oligometastases of Distant Nodes as the Initial Relapse Site of Uterine Sarcoma: A Case Report

子宮肉瘤不尋常的遠端寡轉移：案例報告

熊佩韋(Pei-Wei Shueng) ； 何懷德(Christopher Ho) ； 魏銘洲(Ming-Chow Wei) ； 蔡建誠(Chien-Chen Tsai) ； 謝忱希(Chen-Hsi Hsieh)

《放射治療與腫瘤學》 20卷4期 (2013/12) Pp. 315-321

https://doi.org/10.6316/TRO/201320(4)315

摘要

“未分化”子宮肉瘤，“高惡性度”子宮內膜基質肉瘤（ESS），是種少見且預後不佳的惡性腫瘤。一位48歲女性在本院診斷為“未分化”子宮肉瘤，經過手術與輔助性骨盆腔放射線照射後，在第五個月與第九個月分別發生左側鎖骨上窩與左側腋下淋巴結轉移。左側鎖骨上窩之淋巴結給與根除性放射治療。而左側腋下淋巴結則施以淋巴結摘除術並追加放射線治療。患者治療至今已達五年，目前仍無癌症而存活。左側鎖骨上窩暨腋下淋巴轉移對“未分化”子宮肉瘤乃為罕見案例，縱使病人發生遠端寡轉移，此類患者，若經積極放射線治療仍能有效延長病患存活時間。

關鍵字

子宮肉瘤 ； 導航螺旋刀 ； 影像導航放射技術 ； 鎖骨上窩轉移

並列摘要

”Undifferentiated” uterine sarcoma, or ”high-grade” endometrial stromal sarcoma (ESS), is a rare neoplasm characterized by early visceral organ dissemination and poor prognosis. We present a case of a 48-year-old woman with ”undifferentiated” uterine sarcoma. She was treated and staged by surgery with adjuvant pelvic irradiation. Metastases of left supraclavicular fossa (SCF) and axillary nodes developed 5 and 9 months after the surgery. Salvage radiotherapy alone was delivered to left SCF region. Furthermore, axillary nodal dissection followed by local radiotherapy was done for left axillary Iymphadenopathies. She is alive without evidence of disease and doing well 64 months after the diagnosis of uterine sarcoma. In conclusion, isolated SCF and axillary lymph node metastases are unusual sites of relapse for ”undifferentiated” uterine sarcoma. Aggressive radiotherapy with or without surgery may achieve longer survival for such patients with oligometastases of distant nodes.

並列關鍵字

Endometrial stromal sarcoma ； Helical tomotherapy ； Image-guided radiotherapy ； Supraclavicular metastases