49例卵巢子宫内膜异位症恶变的临床病理分析  

Malignant Transformation of Ovarian Endometriosis:A Clinicopathologic Analysis of 49 Cases

作　　者：沈扬眉[1] 吴秀丽[1] 徐炼[1] 黄芹[1] 于娜[1] 姚先莹[1] 谢宇平 

机构地区：[1]四川大学华西第二医院病理科,四川成都610041 [2]核工业416医院病理科,四川成都610051

出　　处：《癌症》2008年第10期1106-1110,共5页Chinese Journal of Cancer

摘　　要：背景与目的:卵巢子宫内膜异位症是常见妇科良性疾病,异位的子宫内膜与原位的子宫内膜一样,都具有恶性潜能。本研究探讨49例卵巢子宫内膜异位症恶变的临床病理学特征,以及雌激素受体(estrogen receptor,ER)和孕激素受体(progesterone receptor,PR)在卵巢子宫内膜异位症恶变和无恶变卵巢子宫内膜异位症之间的表达差异。方法:对49例卵巢子宫内膜异位症恶变(恶变组)的临床病理学特征进行回顾性研究,应用ER、PR抗体对恶变组及49例无恶变卵巢子宫内膜异位症(对照组)进行免疫组织化学染色和统计学分析。结果:49例卵巢子宫内膜异位症恶变患者为29～70岁,中位年龄49岁。首发症状多为发现盆腔包块,B超检查提示盆腔混合性囊实性包块,术后肉眼检查见包块呈囊实性,直径4.0cm～20.0cm,囊内壁粗糙呈棕或黄色,内有咖啡色粘稠液体,实性区呈菜花样或乳头状的增生物,质脆或嫩,直径0.5cm～15.0cm。镜下见恶变组中的异位宫内膜腺上皮发生不典型增生及恶变。恶变组和对照组ER阳性率分别为20.4%(10/49)和95.9%(47/49),PR阳性率分别为14.3%(7/49)和95.9%(47/49),两者之间都有统计学意义(P<0.05)。结论:卵巢子宫内膜异位症恶变多发于围绝经期妇女,结合患者临床表现、B超结果以及病理检查都有助于疾病诊断。异位子宫内膜ER、PR抗体的表达阴性可作为诊断的依据之一。BACKGROUND ＆ OBJECTIVE. Ovarian endometriosis is a common and benign, but progressive disease. We aimed to investigate the clinicopathologic of ovarian endometriosis with malignant transformation and to evaluate the expression differences of estrogen receptor （ER） and progesterone receptor （PR） between ovarian endometriosis samples with and without malignant transformation. METHODS. Clinicopathologic data of 49 ovarian endometriosis patients with malignant transformation were reviewed. The expression of ER and PR in the 49 specimens of ovarian endometriosis with malignant transformation （transformation group） and 49 specimens of ovarian endometriosis without malignant transformation （control group） were detected by immunohistochemistry and compared statistically. RESULTS： The 49 ovarian endometriosis patients were aged of 29-70 years with a median of 49 years. The major initial manifestation was pelvic masses. B-ultrasound examination showed mixed cystic and solid masses in the pelvic cavity. Macroscopically, the ovarian masses were cystoid and parenchymal with diameters of 4.0-20.0 cm; the cysts possessed thick and fibrous walls （in brown or yellow） and contained chocolate-like fluid or semi-fluid materials; the parenchymal part was tender papillary nodules with diameters of 0.5-15.0 cm. Microscopically, the ectopic endometrium proliferated and transformed to atypical hyperplasia and carcinoma. The positive rates of ER and PR proteins were significantly lower in transformation group than in control group （20.4% vs. 95.9%, 14.3% vs. 95.9%, P〈0.05）. CONCLUSIONS. The malignant transformation of ovarian endometriosis is likely to occur in peri-menopausal women. Clinical manifestations, B-ultrasound examination and pathologic examination are valuable for diagnosis. The absence of ER and PR protein expression in endometriosis may help to diagnose malignant transformation of ovarian endometriosis.

关 键 词：卵巢 子宫内膜异位症 恶变 免疫组织化学染色 

分 类 号：R737.31[医药卫生—肿瘤] R711.71[医药卫生—临床医学]