子宫内膜微腺体癌的临床病理特征与鉴别诊断  

Clinicopathological features and differential diagnosis of endometrial microglandular adenocarinoma

作　　者：杨静[1] 史文利[2] 刘国荣[1] 杜洪[1] 

机构地区：[1]广州市第一人民医院病理科,广州510180 [2]广州市第一人民医院南沙分院病理科,广州510180

出　　处：《广州医药》2015年第6期9-12,共4页Guangzhou Medical Journal

摘　　要：目的探讨子宫内膜微腺体癌的临床病理特征、诊断及鉴别诊断。方法对1例首诊误诊为子宫颈微腺体增生的子宫内膜微腺体癌病例进行临床、病理组织学及免疫组织化学特征的观察及总结,同时进行相关文献复习。结果本例患者年龄61岁,因绝经后阴道不规则流血1年就诊,B超提示子宫内膜不规则增厚,并行分段诊刮术,先后两次诊刮标本光镜下均见黏液性柱状上皮呈乳头状及网格状结构,细胞轻度异型,核分裂罕见,间质内大量中性粒细胞浸润伴腺上皮内"微脓肿"形成;免疫组化示:上皮成分P16弥漫强(+),CEA小灶(+),Vimentin弥漫(+),ER约90%(+,中-强),PR约90%(+,弱),Ki-67约3%(+),间质细胞CD10(+)、CD34(-)。结论子宫内膜微腺体癌是一种极为罕见的子宫内膜黏液腺癌,其组织学形态与子宫颈良性病变微腺体增生十分相似,易于混淆,但通过免疫组化检查及详细地临床病史资料收集、分析,可以与其鉴别,从而做出正确地诊断。Objective To investigate clinical and histopathological features,dignosis and differential diagnosis of the endometrial microglandular adenocarinoma（ MGA）. Methods The clinical and pathological features of microglandular adenocarinoma in a patient were observed. Immunohistochemical staining and literature review were also used. Results In the case,the age of patient was 61 years. Clinical manifestation was vaginal irregular bleeding for 1 year. Type-B ultrasound suggested endometrium was irregular thickening. Histologically,it was mainly composed of irregular shape,closely spaced small glands,and glandular cells was mild atypical. Mitosis was rarely observed. The endometrial stromata between gland were rare,but neutrophil were much observed with the formation of neutrophil microabscess in the glandular epithelium. Immunohistochemical study showed neoplastic cells were diffuse and strongly positivity for P16,diffuse positivity for vimentin,focally positive for CEA. ER and PR expression was found in approximately 90% tumor cells. The index of Ki-67 was about 3%. Interstitial cells were positivity for CD10,negativity for CD34. Conclusion The microglandular adenocarcinoma is a rare endometrial adenocarcinoma. It can be differentiated from cervical microglandular hyperplasia（ MGH） and cervical mucinous adenocarcinoma by immunohistochemistry and morphological characteristics.

关 键 词：子宫内膜微腺体癌 子宫颈黏膜微腺体增生 鉴别诊断 

分 类 号：R737.33[医药卫生—肿瘤]