探讨复发性子宫内膜异位症(EMS)恶变为阴道残端腺肉瘤患者的临床表现、诊断及治疗方法。

选择2024年12月于四川大学华西第二医院诊治的1例复发性EMS恶变为阴道残端腺肉瘤患者(患者1)为研究对象。采用回顾性分析方法，分析其临床病例资料，包括病史、临床表现、影像学检查结果、病理学特征、治疗及随访结果等。以"adenosarcoma""vaginal stump""endometriosis"等为中、英文关键词，检索中国知网数据库、万方数据知识服务平台及维普中文期刊服务平台与PubMed、Web of Science(WoS)中关于EMS恶变为阴道残端腺肉瘤的相关文献，并对该类患者的病史、临床表现、影像学检查结果、病理学特征、治疗及随访结果进行综合分析。本研究遵循的程序符合四川大学华西第二医院伦理委员会制定的标准，并获得该伦理委员会批准[审批文号：2025(315)]。

①患者1为复发性EMS恶变为阴道残端腺肉瘤患者，51岁，G₃P₁，因"发现阴道残端包块1^＋年"于2024年12月18日在本院妇科就诊。患者1既往有EMS病史，本次因阴道残端包块逐渐增大，并伴阴道出血收入本院治疗。入院前，其盆腔MRI检查结果提示阴道残端及左侧盆腔多发结节、团块影；糖类抗原(CA)125及CA19-9水平均升高，阴道残端病灶组织穿刺活检未提示明确恶性病变。本次入院后，对其进行经腹阴道残端病灶切除术的术后组织病理学检查证实为息肉样EMS恶变为腺肉瘤，肉瘤成分含子宫内膜间质肉瘤及横纹肌肉瘤。术后对其盆腔外照射联合6个周期化疗，末次化疗后7个月时未见肿瘤残留或复发。②文献复习结果：采用本研究设定文献检索策略，共检索到关于EMS恶变为阴道残端腺肉瘤患者相关研究文献为7篇，加上患者1，本研究共计纳入8例该病患者，对其病史、临床表现、影像学检查结果、病理学特征、治疗及随访结果进行综合分析如下。这8例患者的中位年龄为48.5岁，临床表现以阴道出血为主(患者1~3、5)，盆腔肿物为3例(患者6~8)，尿失禁及阴道肿物脱垂为1例(患者4)。3例(患者1、5、8)肉瘤成分存在异源性分化，2例(患者2、3)存在肉瘤成分过度生长。这8例患者均接受手术治疗，1例(患者2)腺肉瘤复发后死亡，3例(患者5、6、8)腺肉瘤复发后经过治疗获得缓解，另外4例(患者1、3、4、7)初次治疗后在随访期内均未复发。

EMS恶变致阴道残端腺肉瘤患者临床较为罕见，临床及影像学表现缺乏特异性，确诊需依赖组织病理学检查。手术为主要治疗方式，术后辅助放疗和(或)化疗需结合病理学特征及个体情况综合决定。

To explore the clinical manifestations, diagnosis, and treatment of recurrent endometriosis (EMS) that has undergone malignant transformation into vaginal stump adenosarcoma.

A patient with vaginal stump adenosarcoma arising from recurrent EMS, who was treated at West China Second University Hospital, Sichuan University, in December 2024 (patient 1), was selected into this study. A retrospective analysis of the patient′s clinical records was conducted, including medical history, clinical presentation, imaging findings, pathological characteristics, treatment, and follow-up results. Using Chinese and English keywords such as " adenosarcoma" " vaginal stump" and " endometriosis", we searched the CNKI, Wanfang, and VIP databases, as well as PubMed and Web of Science (WoS), for relevant literature on the malignant transformation of endometriosis into vaginal stump adenosarcoma, and conducted a comprehensive analysis of the medical history, clinical manifestations, imaging findings, pathological characteristics, treatment, and follow-up outcomes of these patients. The procedures followed in this study complied with the standards set by the Ethics Committee of West China Second University Hospital, Sichuan University, and were approved by the Ethics Committee [Approval No.2025(315)].

① Patient 1, a 51-year-old woman (G₃P₁), presented to the Gynecology Department of our hospital on December 18, 2024, with a chief complaint of " a mass at the vaginal stump discovered over a year ago". Patient 1 has a history of EMS and was admitted to our hospital due to a gradually enlarging mass at the vaginal stump accompanied by vaginal bleeding. A pelvic MRI performed prior to admission revealed multiple nodular and mass-like lesions in the vaginal stump and the left pelvis. Elevated levels of carbohydrate antigens (CA) 125 and CA19-9 were observed; however, a needle biopsy of the vaginal stump lesion did not reveal any definitive evidence of malignancy. Following admission, the patient underwent resection of the vaginal stump lesion by laparotomy. Postoperative pathological examination confirmed that the polypoid EMS had undergone malignant transformation into adenosarcoma, with the sarcomatous component consisting of endometrial stromal sarcoma and rhabdomyosarcoma. Postoperatively, the patient received pelvic external beam radiation therapy combined with six cycles of chemotherapy. Seven months after the last cycle of chemotherapy, no residual tumor or recurrence was observed. ②Literature review results: Using the literature search strategy established in this study, a total of 7 research articles related to the malignant transformation of EMS into vaginal stump adenosarcoma were identified. Including patient 1, a total of 8 relevant patients were included in the study. A comprehensive analysis of their medical histories, clinical presentations, imaging findings, pathological characteristics, treatment, and follow-up results is presented below.The median age of these 8 patients was 48.5 years old. The primary clinical manifestation was vaginal bleeding (patients 1-3, and 5); pelvic masses were present in 3 cases (patients 6-8); and urinary incontinence and vaginal mass prolapse were present in 1 case (patient 4). In addition, three cases (patients 1, 5, and 8) exhibited heterotopic differentiation of the sarcomatous component, and two cases (patients 2 and 3) showed overgrowth of the sarcomatous component. All 8 patients underwent surgical treatment. One patient (patient 2) died following a recurrence; 3 patients (patients 5, 6, and 8) achieved remission following treatment after recurrence; and the remaining 4 patients (patients 1, 3, 4, and 7) did not experience recurrence during the follow-up period after their initial treatment.

Vaginal stump adenosarcoma arising from the malignant transformation of EMS is a relatively rare clinical condition, and lacks specific clinical and imaging features. Definitive diagnosis mainly relies on histopathological examination. Surgical resection remains the primary treatment, and the decision to administer adjuvant radiation therapy and/or chemotherapy after surgery should be made based on a comprehensive assessment of pathological characteristics and individual patient circumstances.