息肉样子宫内膜异位症的临床及病理特征  

Clinical and Pathological Features of the Polypoid Endometriosis

作　　者：宋玉芳[1] 韩璐[1] SONG Yu-fang;HAN Lu(Department of Gynecology,Dalian Obstetrics and Gynecology Hospital, Affiliated Hospital of Dalian Medical University,Dalian 116033,China)

机构地区：[1]大连医科大学附属大连市妇产医院暨大连市妇幼保健院妇科,116033

出　　处：《国际妇产科学杂志》2017年第4期463-467,共5页Journal of International Obstetrics and Gynecology

摘　　要：息肉样子宫内膜异位症(polypoid endometriosis,PEM)是子宫内膜异位症(endometriosis,EMs)的一种罕见亚型,可出现于全身任何部位。PEM发病年龄范围较广,23~78岁不等,不同地区报道其好发年龄不同。PEM属于局部异位内膜的过度生长,其确切发病机制不明,有待进一步研究。临床表现与生长部位有关,呈多样性。临床表现以病变部位包块、肿瘤引起症状体征及压迫症状体征为主,如盆腔包块、腹股沟区包块、阴道出血、肾积水、腰部疼痛、膀胱占位等,部分临床表现类似恶性肿瘤。大体特征为囊肿内生或外生性息肉样肿块;镜下特征具有普通EMs的病理学特点,病变组织均由子宫内膜样腺体及间质成分构成,但比普通EMs更具多样性;免疫组织化学检查PEM组织内雌激素受体(ER)、孕激素受体(PR)、糖蛋白抗原10(CD10)、波形蛋白(Vimentin)表达阳性。诊断主要依靠病理学检查,血清糖类抗原125(CA125)异常增高及磁共振成像(MRI)有助于对其诊断,治疗多以手术切除病灶为主,对于阴道、盆腔多部位PEM在无法完全切净的情况下,去势手术对PEM同样有效,PEM预后良好。The polypoid endometriosis(PEM)is a rare subtype of endometriosis(EMs),and it can appear anywhere of the body.The age of PEM incidence is wide,ranging from23to78years of age,different areas reported a different age.PEM is the excessive growth of local ectopic endometrium.The exact mechanisms of PEM remain controversial and still need more researches.PEM′s clinical manifestations are associated with the growth sites,showing diversity.The main clinical manifestations are the mass or the symptoms and signs caused by tumor of the lesions,such as pelvic mass,inguinal mass,vaginal bleeding,hydronephrosis,waist pain,bladder mass and so on.Some manifestations are similar to malignant tumors′behavior.Generally characterized by a cyst inside,or pedunculated polyp-like masses.Endoscopic characteristics have ordinary EMs pathology,the lesions are composed of endometrial glandular and stromal components,but more than the ordinary Ems diversity.The expressions of immunohistochemistry of ER,PR,CD10and Vimentin are positive in the PEM tissues.The diagnosis of PEM is mainly based on pathology,and abnormal increase of the serum CA125and MRI may be helpful for the diagnosis.The treatment is mainly surgical resection,and the bilateral variectomy is equally effective in case of vaginal and pelvic multiple sites without complete resection.The prognosis of the disease is good.

关 键 词：子宫内膜异位症 诊断 治疗 预后 息肉样子宫内膜异位症 

分 类 号：R711.71[医药卫生—妇产科学]