子宫内膜间质肉瘤55例临床病理特点和预后分析  

Clinicopathologic features and prognostic factors of endometrial stromal sarcoma： a study of 55 cases

作　　者：史景丽[1] 成宁海[2] 郭丽娜[1] 连利娟[2] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院病理科,100730 [2]中国医学科学院北京协和医学院北京协和医院妇产科,100730

出　　处：《中华病理学杂志》2011年第8期517-522,共6页Chinese Journal of Pathology

摘　　要：目的了解子宫内膜间质肉瘤（ESS）的病理形态特征并分析影响预后的相关指标。方法收集该院55例ESS患者的临床和病理资料，所有病例重新阅片，参照文献分类为低级别子宫内膜间质肉瘤（LGESS）、不伴核多形的未分化子宫内膜肉瘤（UES-U）、伴有核多形的未分化子宫内膜肉瘤（UES-P）；同时观察肿瘤细胞的形态特点，包括纤维样、肌样、黏液样、上皮样分化，并计数核分裂象等。对所有病例进行临床资料的收集并随访。结果LGESS、UES．U、UES-P型病例分别为39、9、7例。病理形态上，ESS有多种形态分化并存的特点，LGESS、UES-U及UES-P型病例中分别有12．8％（5／39）、5／9及5／7伴有两种以上混合的形态学分化；同一病例的不同区域核分裂象计数和组织学类型亦存在较大差异。临床上肿瘤复发比例分别为51．6％（16／31）、5／6、2／3；LGESS无死亡病例，UES-U和UES-P中各有2例死亡，且UES-U的死亡病例均有局灶UES．P区域。按核分裂象最高计数进行预后分析，≥10／10HPF的病例复发率显著高于〈10／10HPF的复发率（P=0．009），在LGESS病例中亦存在这种统计学差异，所有死亡病例的核分裂象最高计数均〉30／10HPF。结论ESS常见不同程度分化重叠及多向分化的特点，尤以UES-U和UES-P中更为常见，因此应充分取材以寻找诊断线索。肿瘤中伴有UES-P图像，同时伴核分裂象计数高度活跃可能会增加死亡风险。在LGESS病例中，核分裂象最高计数≥10／10HPF的肿瘤复发率显著增高，在诊断时应引起重视。Objective To investigate the clinicopathologic features and the prognostic factors of endometrial stromal sarcoma （ESS）. Methods 55 cases of endometrial stromal sarcoma were reviewed and categorized into 3 pathologic types based on the related literatures, i.e. , low grade endometrial stromal sarcoma （LGESS）, undifferentiated endometrial sarcoma with nuclear uniformity （UES-U） and undifferentiated endometrial sarcoma with nuclear pleomorphism （UES-P）. Meanwhile, the pathologic features were reviewed, including fibroid, myoid, mucoid, and epithelioid differentiation and mitotic index. Clinical and follow-up data were collected. Results In endometrial stromal sarcoma, two or three pathologic types co-existed in one case, including 12. 8% （5/39） of LGESS, 5/9 of UES-U, and 5/7 of UES-P. Mitotic index varied in different regions of one tumor from rare to high. Multi-differentiation was also commonly seen in ESS. The numbers of cases in LGESS, UES-U and UES-P were 39, 9 and 7, with recurrence rate of 51.6% （16/31） , 5/6 and 2/3, respectively. There was no death case in LGESS, and 2 cases were died in UES-U and UES-P, respectively. In the 2 death cases of UES-U, both had focus of UES-P. There was a significant difference in the recurrence rate between cases with different mitotic index （≥ 10/10 HPF and 〈 10/10 HPF,P = 0. 009）, especially in LGESS group. All death cases had high mitotic index （ 〉 30/10 HPF）. Conclusions It is a common phenomenon in ESS that two or three pathologic types may exist in one case, especially in UES-U and UES-P. And multi-differentiation is also commonly seen in ESS. So adequate pathologic sampling is important for pathologists to make a correct diagnosis of ESS in dailv work. The recurrence rates are significantly higher in cases with high mitotic index,especially in LGESS. In addition, the presence of UES-P and high mitotic index may increase the risk of death in the patients.

关 键 词：肉瘤 子宫内膜间质 病理学 临床 预后 

分 类 号：R737.33[医药卫生—肿瘤]