Meizheng Dang,1,* Shangwen Cai,2,3,* Jin Yao,1 Buyi Zhang,4 Lili Zhang,4 Wen Xu,1 Pintong Huang1 

1Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 2Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 3Institute of Gastroenterology, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China; 4Department of Pathology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Pintong Huang, Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangcheng District, Hangzhou, Zhejiang, 310009, People’s Republic of China, Tel +86-18857168333, Email huangpintong@zju.edu.cn Wen Xu, Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangcheng District, Hangzhou, Zhejiang, 310009, People’s Republic of China, Tel +86-15167100536, Email xuwen_zjdx@zju.edu.cn
背景：子宫静脉平滑肌瘤（Intravenous Leiomyomatosis，IVL）是一种罕见的来源于子宫平滑肌的良性肿瘤，其主要特征为沿静脉系统腔内向内或向外性生长。动脉系统受累的情况极为罕见，但一旦发生，往往显著增加手术操作的复杂性，并对患者的预后产生不利影响。

病例报告：本文报道了一例罕见的子宫静脉平滑肌瘤伴髂内动脉受累病例。一名32岁女性患者，顺产后三个月在常规超声随访中偶然发现右侧附件区混合性回声肿块。患者无明显临床症状，既往有腹腔镜子宫肌瘤切除术史。通过经阴道超声、弹性成像、造影超声及磁共振成像综合评估后，考虑病变来源于子宫，术前主要鉴别诊断包括静脉平滑肌瘤与退行性变子宫肌瘤。在排除禁忌症并获得患者及其家属知情同意后，实施了腹腔镜下盆腔及子宫病灶切除术，术中可见肿瘤沿盆腔血管呈囊性、不规则管状生长，远端累及右侧髂内静脉及部分髂内动脉。最后于腹腔镜下完整切除病灶并同步切除受累血管段。病理学显示肿瘤组织由高细胞密度的平滑肌瘤样细胞构成；免疫组化结果示α-SMA、Desmin、ER及PR阳性，FH与SDHB表达正常。弹力纤维染色证实肿瘤侵入血管腔内生长，最终诊断为伴髂内动脉受累的子宫静脉平滑肌瘤。术后患者恢复顺利，未出现明显并发症。

讨论：IVL通常局限于静脉系统内生性生长，动脉受侵较为罕见。其发生机制可能与盆腔动静脉交通形成、术后血管壁损伤或妊娠期激素水平及血流动力学改变有关。在影像学方面，造影超声联合时间–强度曲线分析有助于将本病与子宫肉瘤进行鉴别。病理学上，本案例未见明显细胞异型性及坏死，提示肿瘤具备良性组织学特征。IVL具有激素依赖性生长特点，妊娠及产褥期雌、孕激素水平升高可能促进肿瘤生长与进展。