探讨子宫黏膜下腺肌瘤(SA)的诊断学特征。

回顾性分析2025年2月13日于深圳大学附属华南医院妇科收治的1例子宫SA患者的临床、影像学、实验室及病理资料，总结其诊断学特征。

患者女性，29岁，自2022年无明显诱因出现经量异常，时多时少，经期规则，多时至正常量3倍余，伴有血块，少时为点滴状出血，不伴明显头晕、乏力，无发热、头痛、头晕、视力模糊等不适。超声检查示：子宫内膜异常增厚，内膜厚度从2022年的38 mm增至68 mm，呈大片状不均匀高回声，可见多个不规则囊性回声。增强MRI示宫腔异常信号，考虑良性病变，子宫内膜增生过长伴出血坏死可能。糖类抗原125水平轻度增高(39.8 U/mL)，人附睾蛋白4水平升高明显(98.4 pmol/L)。2024年两次宫腔镜活检病理均提示：子宫内膜增生过长可能。2025年2月行第3次宫腔镜子宫病损电切术＋超声引导下经皮穿刺活检术，病理结果提示SA病变可能。

在经量异常且子宫内膜进行性增厚并伴囊性成分时，应警惕SA；联合MRI评估与定向取材可提高术前诊断准确性。

To explore the diagnostic characteristics of uterine submucosal adenomyoma (SA).

We retrospectively analyzed the clinical, imaging, laboratory, and pathological data of a single patient with SA, who was admitted to the Department of Gynecology, South China Hospital Affiliated to Shenzhen University on February 13, 2025. The diagnostic characteristics of SA were summarized.

This patient was a 29-year-old female with abnormal menstrual bleeding since 2022, without any obvious cause. Menstrual cycles were regular, but flow varied from spotting to episodes over threefold her usual volume, with clots. She didn′t have significant dizziness, fatigue, fever, headache, blurred vision or other discomforts. The ultrasound (US) showed progressive endometrial thickening: 38 mm in 2022, increasing to 68 mm.The endometrium was heterogeneously hyperechoic with multiple irregular cystic components. The enhanced MRI showed abnormal signals in the uterine cavity, suggesting a benign lesion; endometrial hyperplasia with hemorrhage and necrosis was considered. The carbohydrate antigen 125 level mildly elevated (39.8 U/mL), and the human epididymis protein 4 level significantly elevated (98.4 pmol/L). In 2024, histopathology of 2 hysteroscopic biopsies both suggested the possibility of endometrial hyperplasia. In February 2025, the third hysteroscopic resection of uterine lesions and percutaneous uterine biopsy under US guidance suggested the possibility of SA lesion.

Suspicion for SA should be raised in cases of abnormal menstruation flow with progressive endometrial thickening and cystic components. Combining MRI assessment with targeted biopsy can improve preoperative diagnostic accuracy.