类似卵巢性索肿瘤的子宫肿瘤3例临床病理特征分析  

Uterine tumors resembling ovarian sex cord tumors:a clinicopathological analysis of three cases

作　　者：左璇 冯敏[1] 王巍[1] 杨开选[1] 何英[1] ZUO Xuan;FENG Min;WANG Wei;YANG Kai-xuan;HE Ying(Department of Pathology,West China Second Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西第二医院病理科,成都610041

出　　处：《诊断病理学杂志》2021年第3期194-198,共5页Chinese Journal of Diagnostic Pathology

基　　金：中央高校基本科研业务费专项资金资助。

摘　　要：目的探究类似卵巢性索肿瘤的子宫肿瘤(UTROSCT)的临床表现、病理特征、诊断及鉴别诊断与预后相关因素。方法分析3例经HE和免疫组化En Vision两步法染色,诊断为UTROSCT的病例临床及病理资料,并复习相关文献。结果3例中2例系绝经后女性,1例为围绝经期女性;1例因体检发现宫腔占位而就诊,余2例因出现阴道不规则出血、月经改变而就诊。本文所述3例中例1肿瘤位于子宫腔内,余2例肿瘤生长于肌壁间,大体均呈肌瘤样生长,肉眼观与周围组织边界较清。镜下例1中肿瘤局灶可呈锯齿状,形态欠规则,但余2例肿瘤边界较清楚。3例肿瘤细胞均由上皮样细胞构成,各例中均可见肿瘤细胞排布方式的多样性,细胞可排列呈梁状、条索状、巢片状,部分区域可见似卵巢性索-间质肿瘤的管样结构,例2灶区可见泡沫样细胞簇。免疫组化:瘤细胞CK-P、vimentin、Calretinin、WT-1、ER和PR(+),EMA、Pax-8、CK7、CD10均为(-)。3例患者均施行全子宫及双附件切除术。术后平均随访21月,患者一般状况良好,未见复发转移。结论UTROSCT是一类罕见的具卵巢性索肿瘤样形态特征的子宫肿瘤,肿瘤细胞具有多向分化潜能,可伴有平滑肌分化。部分病例尽管Ki-67指数可增高至15%,但未见明显预后不良,未见肿瘤复发与转移。因而Ki-67指数可能无法作为预测肿瘤预后的独立因素。然而,由于随访时间及案例有限,肿瘤的生物学行为及较高的肿瘤细胞增殖指数对疾病预后的影响仍有待研究。Objective To demonstrate the clinicopathological features,diagnosis and differential diagnosis as well as prognosis in patients with uterine tumors resembling ovarian sex cord tumors(UTROSCT).Methods The clinical and pathological data were retrospectively analyzed in 3 cases of UTROSCT followed by hematoxylin and eosin stain,immunohistochemistry in our hospital.Results Two of the 3 patients were postmenopausal and one was perimenopausal female.Patients had no self-conscious symptoms and seeked medical treatment only because of unexpected findings of uterine space-occupying lesions,or because of irregular bleeding and menstrual changes.Among the 3 reported cases,1 tumor was located in the uterine cavity and myometrium and the remaining 2 tumors grew between the muscle walls.All tumors all grew in a myomatoid pattern.Under the microscope,the tumor was all composed of epithelioid cells arranged in different pattern like trabecular,cord and nest.Focal foam cell clusters were seen in case 2.Tube-like structures resembling cord-stromal tumors of the ovary were noted in focal areas.Immunohistochemical staining showed that the tumor cells expressed CK-P,vimentin,calretinin,WT-1,ER and PR.Markers like EMA,CK7 and CD10 were negetive in UTROSCT.All 3 patients underwent total hysterectomy and bilateral adnexectomy.The patients were followed up for an average of 21 months with no recurrence and metastasis.Conclusion UTROCST is a rare tumor with morphological characteristics of ovarian sex cord tumor.Tumor cells have multi-direction differentiation potential and may sometimes be accompanied by smooth muscle differentiation.Although Ki-67 index increases up to 15%in some cases,it has no prognostic significance.Therefore,Ki-67 index may not be an independent predictor of tumor prognosis.Nevertheless,the truly biological behavior and the effect of a higher tumor cell proliferation index on the prognosis of the disease remains to be studied due to our limited follow-up time and small sample size.

关 键 词：类似卵巢性索肿瘤的子宫肿瘤 临床病例特征 诊断及鉴别诊断 

分 类 号：R737.31[医药卫生—肿瘤]