复发性子宫苗勒源腺纤维瘤临床病理分析  

Recurrent M ＆#252;llerian adenofibroma of uterus：a clinicopathologic study of 7 cases

作　　者：石海燕[1] 陈晓端[1] 张晓飞[1] 周彩云[1] 余明华[1] 

机构地区：[1]浙江大学医学院附属妇产科医院病理科,杭州310006

出　　处：《中华病理学杂志》2014年第5期321-325,共5页Chinese Journal of Pathology

摘　　要：目的：探讨复发性子宫苗勒源腺纤维瘤的临床病理学特征及鉴别诊断要点。方法回顾性复习1992年1月至2006年4月7例复发性子宫腺纤维瘤患者的临床病理资料，比较肿瘤复发前后组织学形态特点及变化，同时选择经随访临床经过良性的腺纤维瘤12例和低级别腺肉瘤14例，进行免疫组织化学EnVision法染色，比较雌激素受体（ ER）、孕激素受体（ PR）、平滑肌肌动蛋白（ SMA）、CD10、p53及Ki-67的表达情况。结果7例复发性腺纤维瘤均表现为宫腔或宫颈外生性广基分叶状赘生物，镜下原发肿瘤由良性上皮及良性间叶成分混合组成，间质细胞核分裂象≤1/10 HPF。复发肿瘤中3例保持良性形态，4例伴有局部腺肉瘤改变。 ER、PR、SMA及p53在良性腺纤维瘤、复发性腺纤维瘤和低级别腺肉瘤中的表达差异无统计学意义。 CD10在良性腺纤维瘤及复发腺纤维瘤中通常不表达或仅有局灶弱表达（分别为1/12和1/7），而在腺肉瘤中有较高的表达比例（9/14，P＜0.05）。3组的Ki-67阳性指数差异无统计学意义（P＞0.05），但腺肉瘤中Ki-67在腺体周围间质带表达强于腺体之间的间质，腺纤维瘤则无此现象。结论复发性腺纤维瘤可能具有未确定的生物学行为或交界性特征，与低级别腺肉瘤鉴别诊断困难，CD10及Ki-67免疫组织化学染色可能有助于诊断。Objective To study the clinicopathologic features and differential diagnosis of recurrent M＆#252;llerian adenofibroma （ MAF） of the uterus.Methods Clinicopathologic information of 7 cases of recurrent MAF of uterus was retrieved from January 1992 to April 2006 and compared with 12 cases of MAF without recurrence and 14 cases of low-grade M＆#252;llerian adenosarcoma （ MAS ）. EnVision immunohistochemistry of estrogen receptor （ ER ） , progesterone receptor （ PR ） , smooth muscle actin （SMA）, CD10, Ki-67 and p53 were performed in all cases.Results All cases of recurrent MAF of the uterus were polypoid , lobulated, and broad based mass arising from the corpus or cervix .Microscopically , the tumor consisted of benign epithelial and mesenchymal components with low mitotic activity （≤1/10 HPF） .The clinical and pathologic features of 3 recurrent tumors were similar to their primary tumors , while 4 cases of recurrent tumor presented with focally higher cellularity and mitotic activity , meeting the diagnostic criteria of adenosarcoma .The stromal expression patterns of ER , PR, SMA and p53 in recurrent MAF were similar to those of clinically benign MAF and low-grade MAS.Negative or focally positive stromal cell expression of CD10 was seen infrequently in recurrent MAF （1/7） and clinically benign MAF （1/12）. In contrast, a moderate to strong CD10 staining was frequently seen in MAS （9/14, P ＆lt;0.05）.The difference of Ki-67-labeling index between MAF and MAS did not reach a statistical significance （ P ＆gt;0.05 ） . Ki-67-labeling index increased in areas of periglandular stromal cuffing as compared with interglandular areas in all MAS cases , but it was not observed in either recurrent MAF or clinically benign MAF cases.Conclusions Recurrent MAF may be associated with aggressive behavior .It is difficult to distinguish MAF from low-grade MAS.CD10 and Ki-67 staining pattern in stromal cells may be helpful for the differential diagnosis .

关 键 词：子宫肿瘤 苗勒管 腺纤维瘤 诊断 鉴别 复发 

分 类 号：R737.33[医药卫生—肿瘤]