山东医药

目的 总结以特鲁索综合征(TS)为首发表现的子宫内膜和卵巢双原发子宫内膜样腺癌的有效诊断及治疗方法。方法 对1例以TS为首发表现的子宫内膜和卵巢双原发子宫内膜样腺癌患者的临床资料作回顾性分析。结果 47岁女性患者，因头痛就诊，后出现多发性、复发性血栓事件和恶性肿瘤影像特征，考虑TS可能。经利伐沙班抗凝治疗后出现阴道出血，暂停利伐沙班后，使用依诺肝素进行过渡性抗凝，加用依达拉奉右崁醇、丁苯酞注射液进行神经保护治疗。患者脑梗死症状缓解后，接受紫杉醇+卡铂静脉化疗3个疗程。因患者及家属强烈要求手术，行开腹全子宫切除+双侧附件切除+大网膜切除+阑尾切除术，手术顺利。术后病理检查结果提示：(右卵巢)中-低分化子宫内膜样腺癌，(子宫内膜)中分化子宫内膜样腺癌。免疫组化结果提示：子宫内膜病灶ER/PR部分区域阴性，卵巢病灶ER/PR强阳性。患者病情稳定后出院。结论 部分子宫内膜和卵巢双原发子宫内膜样腺癌患者可以TS为首发表现，且多发性癌灶可能加剧TS的严重程度。子宫内膜和卵巢双原发子宫内膜样腺癌的诊断需综合组织病理学、分子检测与临床表现，早期宜采用以低分子肝素为基础的抗凝方案以平衡血栓与出血风险，并在患者情况允许时通过手术和化疗最大限度降低肿瘤负荷。

Objective To summarize the effective diagnostic and treatment strategies for synchronous primary endometrioid adenocarcinoma of the endometrium and ovary with Trousseau syndrome(TS) as the initial manifestation. Methods The clinical data of a patient with synchronous primary endometrioid adenocarcinoma of the endometrium and ovary initially presenting with Trousseau syndrome(TS) were retrospectively analyzed. Results A 47-year-old woman initially presented with headache, followed by multiple recurrent thrombotic events and imaging findings suggestive of malignancy, leading to suspicion of Trousseau syndrome(TS). Vaginal bleeding occurred after rivaroxaban anticoagulation, and enoxaparin was subsequently used for bridging anticoagulation. Neuroprotective therapy was also administered. After improvement of cerebral infarction symptoms, the patient received three cycles of paclitaxel plus carboplatin chemotherapy, followed by open total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and appendectomy. Surgeries went well. Postoperative pathology revealed moderately to poorly differentiated endometrioid adenocarcinoma of the right ovary and moderately differentiated endometrioid adenocarcinoma of the endometrium. Immunohistochemistry showed partial ER/PR negativity in the endometrial lesion and strong ER/PR positivity in the ovarian lesion. The patient was discharged in stable condition. Conclusions Synchronous primary endometrioid adenocarcinoma of the endometrium and ovary may present initially with TS, and multifocal lesions may exacerbate its severity. Its diagnosis requires comprehensive evaluation of histopathology, molecular findings, and clinical manifestations. In the early stage, low-molecular-weight heparin-based anticoagulation may help balance thrombotic and bleeding risks, while surgery and chemotherapy should be undertaken, when feasible, to reduce tumor burden to the greatest extent possible.