子宫肌壁间小叶样分割性平滑肌瘤5例临床病理分析  

Intramural cotyledonoid dissecting leiomyoma of the uterus: a clinicopathological study of five cases

作　　者：詹阳[1] 潘静[1] 谷玉春[1] 阴赪宏[1] 支文雪[1] 宋菡姝[1] 徐汉武 徐飞[1] 朱力[1] 

机构地区：[1]首都医科大学附属北京妇产医院病理科,北京100006

出　　处：《诊断病理学杂志》2017年第1期3-6,10,共5页Chinese Journal of Diagnostic Pathology

基　　金：首都医科大学附属北京妇产医院院内课题(编号2013-02)

摘　　要：目的探讨子宫肌壁间小叶样分割性平滑肌瘤(CDL)的临床病理学特征、诊断与鉴别诊断及预后。方法对5例子宫肌壁间小叶样分割性平滑肌瘤病例的临床表现、病理学、免疫组化特征进行回顾性分析并复习相关文献。结果 5例患者均因阴道异常出血和/或盆腔包块就诊,年龄平均44.8岁。大体表现为肌壁间结节状肿物分界不清,质地较软。镜下肿瘤性平滑肌细胞束形成大小不等的微结节状,边缘可以呈"舌状"或"指状"突起伸入正常平滑肌组织中,表现为"分割样"形态。免疫组化:SMA、actin和PR均(+),ER(+)/弱(+),CD10、HMB45、CD34和CD117均(-),Ki-67阳性指数低。随访17~61个月,均未发现肿瘤复发和转移。结论子宫肌壁间小叶样分割性平滑肌瘤是一种罕见的子宫肿瘤,好发于生育晚期及围绝经期女性,预后良好。分隔样生长方式是重要的病理特点,免疫组化有助于鉴别诊断,手术是有效的治疗手段。To explore the clinieopathological features, diagnosis, differential diagnosis and prognosis of intramural cotyledonoid dissecting leiomyoma in the uterus. Methods The elinicopathologieal and immunohistochemical data were analyzed in 5 cases of uterine intramural cotyledonoid dissecting leiomyoma, with follow - up and review of related literature. Results Five patients were admitted to the hospital because of abnormal vaginal bleeding and/or pelvic mass, with an average age of 44. 8 years. Grossly, intramural nodular tumors were characterized by ill-defined borders and soft texture. Microscopically, the tumorous smooth muscle cells formed micronodules of varying sizes. In the tumorous edge, abnormal smooth muscle extended significantly into the normal smooth muscle tissue like the ＂tongue＂ or ＂finger＂, as ＂dissecting＂ growth pattern. Immunohistoehemistry showed SMA, aetin and PR were positive, ER was positive/weak positive, and CD10, HMB45, CD34 and CD117 were negative. Ki67 index was lower. During a follow-up period of 17 - 61 months, and the patients were no tumor recurrence and metastasis. Condusiorts The intramural cotyledonoid dissecting leiomyoma of the uterus is a rare tumor with a good prognosis, which is commonly found in the women of later reproductive or perimenopausal age. The ＂dissecting＂ growth pattern is the most important pathological character, and immunohistochemstry is useful for differential diagnosis. Surgery is an effective treatment.

关 键 词：小叶样分割性平滑肌瘤 子宫肌壁间 分割样 病理学 免疫组化 

分 类 号：R737.33[医药卫生—肿瘤]