Clinical characteristics of malignant pelvic tumors after hysterectomy for benign lesions
CHEN Fang, ZHANG Ying, GUO Yinshu
Department of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University/Beijing Maternal and Child Health Care Hospital, Beijing 100006, China
Abstract：Objective To analyze the clinical characteristics of malignant pelvic tumors after hysterectomy for benign lesions. Methods A total of 72 patients who underwent total or subtotal hysterectomy due to benign uterine or adrenal lesions were collected from Beijing Obstetrics and Gynecology Hospital affiliated to Capital Medical University from January 2013 to June 2022. According to pathological types of pelvic masses after hysterectomy, they were divided into benign disease group (49 cases) and malignant tumor group (23 cases). The clinical features and risk factors were analyzed retrospectively. Results The age at hysterectomy, the age at the discovery of pelvic mass, and the time interval between the occurrence of pelvic mass and hysterectomy in the malignant tumor group were higher than those in the benign tumor group, with statistical significance (P<0.05). In the malignant tumor group, 73.9% of the patients had abdominal pain, abdominal distension, vaginal bleeding or drainage and other clinical symptoms, while only 26.1% of the patients were found during physical examination, and the difference was statistically significant compared with the benign disease group (P<0.05). The ultrasound images of all patients in the malignant tumor group showed solid or cystic solid pelvic masses with large volume, accompanied by increased tumor markers of different degrees, and the difference was statistically significant compared with the benign tumor group (P<0.05). Conclusions Malignant tumors are more likely to occur in older patients with hysterectomy with interval of more than 5 years, and most patients have clinical symptoms. Once pelvic masses are found in such patients, comprehensive analysis should be carried out in combination with the imaging characteristics of the tumor, the level of serum tumor markers, and the symptoms of the patients, and early surgical treatment should be performed to avoid the delay of the disease.
Society of Gynecologic Oncology.SGO Clinical practice statement:salpingectomy for ovarian cancer prevention.Chicago(IL):SGO2013[EB/OL].[2023-02-23].https://www.sgo.org/clinical-practice/guidelines/sgo-clinical-practice-statement-salpingectomy-forovarian-cancer-prevention/.
[2]
Holub Z,Jandourek M,Jabor A,et al.Does hysterectomy without salpingo-oophorectomy influence the reoperation rate for adnexal pathology? A retrospective study[J]. Clin Exp Obstet Gynecol,2000,27(2):109-112.
[3]
Pynnä K, Vuorela P, LodeniusL, et al.Cost-effectiveness of hysterectomy for benign gynecological conditions: a systematic review[J]. Acta Obstet Gynecol Scand, 2014, 93(3):225-232.
[4]
Evans E C,Matteson K A,Orejuela F J,et al.Society of Gynecologic Surgeons Systematic Review Group. Salpingo-oophorectomy at the time of benign hysterectomy: a systematic review[J].Obstet Gynecol,2016, 128(3):476-485.
[5]
Naz F, Begum A.Experience with pelvic masses following hysterectomyfor benign disease[J]. Biomedica,2004, 20:106-109.
[6]
Meng B,Xu M.Pelvicartificial isolation with ultrasound-guided fluid: a new technique in ovarian endometriotic cyst transabdominal sclerotherapy[J]. Med Sci Monit, 2022, 28:e937855.
[7]
Chao X,Wang X,Xiao Y,et al.Clinical analysis of high risk factors for pelvic malignant tumors after hysterectomy for benign diseases[J].Medicine (Baltimore), 2019, 98(41):e17540.
[8]
Ducie J,Dao F,Considine M,et al. Molecular analysis of high-grade serous ovarian carcinoma with and without associated serous tubal intra-epithelial carcinoma[J]. Nat Commun,2017, 8(1):990.
Salvador S,Scott S,Francis J A, et al. No. 344-opportunistic salpingectomy and other methods of risk-reduction for ovarian/fallopian tube/peritoneal cancer in the general population[J].J Obstet Gynaecol Can,2017,39(6):480-493.
[11]
Kim M,Kim Y H,Kim Y B,et al.Bilateral salpingectomy to reduce the risk of ovarian/fallopian/peritoneal cancer in women at average risk:a position statement of the Korean Society of Obstetrics and Gynecology(KSOG)[J].Obstet Gynecol Sci,2018,61(5): 542-552.
[12]
ACOG.ACOG committee opinion No.774: opportunistic salpingectomy as a strategy for epithelial ovarian cancer prevention[J].Obstet Gynecol, 2019, 133(4): e279-e284.
Meys E M, Kaijser J, Kruitwagen R F,et al.Subjective assessment versus ultrasound models to diagnose ovarian cancer: a systematic review and meta-analysis[J].Eur J Cancer,2016,58:17-29.
2023, Vol. 34 
