子宫内膜间质肉瘤和低分化子宫内膜样腺癌的病理特征及鉴别诊断  

Pathological features of endometrial stromal sarcoma and poorly-differentiated endometrial adenocarcinoma and differential diagnosis

作　　者：喇慧[1] 韦贞汁 曲丽霞[1] 权丽丽[1] 

机构地区：[1]三门峡市中心医院妇科,河南三门峡472000

出　　处：《现代肿瘤医学》2017年第5期782-784,共3页Journal of Modern Oncology

基　　金：三门峡市科技攻关基金项目(编号:2011030326)

摘　　要：目的:探讨子宫内膜间质肉瘤和低分化子宫内膜样腺癌临床病理特征和鉴别诊断,以期提高诊断准确性。方法:回顾性分析2010年1月-2013年1月12例子宫内膜间质肉瘤和12例低分化子宫内膜样腺癌患者,分别从巨检、镜检、免疫组化三方面进行总结。结果:子宫内膜间质肉瘤肿块切面大部分灰白、灰黄色、无明显出血坏死。低分化子宫内膜样腺癌表面内膜增厚、粗糙、质脆,表面凹凸不平,子宫切面有些肉眼可见肌层浸润。镜检子宫内膜间质肉瘤呈不规则舌状或岛状浸润肌层,有突入淋巴管、血管内生长、肿瘤细胞密集。肿瘤内可见较薄壁螺旋小血管,血管周围肿瘤细胞同心圆样排列,缺乏子宫内膜间质细胞分化特点和典型生长方式,无螺旋小血管,伴盆腔淋巴结转移。子宫内膜间质肉瘤ER阳性率为25%,PR阳性率为8.33%,而低分化子宫内膜样腺癌ER阳性率为100%,PR阳性率为100%,两组比较差异显著(P<0.05)。结论:子宫内膜间质肉瘤和低分化子宫内膜样腺癌在镜检和免疫组化上可予区分。Objective： To investigate the endometrial stromal sarcoma and poorly-differentiated endometrial adenocarcinoma clinical and pathological features and differential diagnosis,in order to improve accuracy. Methods： A retrospective analysis in January 2010 to January 2013,12 endometrial stromal sarcoma and 12 cases of poorly-differentiated endometrial adenocarcinoma patients were summarized from grossly,microscopy,immunohistochemistry.Results： Endometrial stromal sarcoma tumor section most gray,pale yellow,no significant bleeding and necrosis. Poorly-differentiated endometrial adenocarcinoma showed slice surface intimal thickening,rough,brittle,uneven surface,uterine section some visible muscle invasive. Under microscopy endometrial stromal sarcoma showed tongue irregular island myometrial invasion,there broking into lymphatic vascular growth within the tumor cell density. It founded that relatively thin-walled spiral visible small blood vessels around the tumor blood vessels within the tumor cells arranged like concentric circles,the lack of endometrial stromal cell differentiation characteristics and typical growth pattern,no spiral of small blood vessels,associated with pelvic lymph node metastases. Poorly-differentiated endometrial adenocarcinoma showed more glandular glands,a few fine papillary,size and arrangement of extremely inconsistent to disappear,densely crowded glands,epithelial cell proliferation disorder,enlarged nuclei,nuclear cytoplasm ratio imbalance,infiltrate fibrous tissue surrounding obvious reaction. Endometrial stromal sarcoma ER positive rate was 25%,PR positive rate was 8. 33%,while the poorly-differentiated endometrial adenocarcinoma ER-positive rate was 100%,PR positive rate of 100%,the difference was significant（ P〈0. 05）. Conclusion： Endometrial stromal sarcoma and poorly-differentiated endometrial adenocarcinoma is liable to differentiate on the examination and immunohistochemistry.

关 键 词：子宫内膜间质肉瘤 低分化子宫内膜样腺癌 临床诊断 鉴别诊断 

分 类 号：R737.33[医药卫生—肿瘤]