伴有术后不良复发的子宫平滑肌瘤30例临床病理分析  

Uterine leiomyoma with postoperative adverse recurrence:a clinicopathological analysis of 30 cases

作　　者：吴文清[1] 姚伶俐 王方平 翁海燕 WU Wen-qing;YAO Ling-li;WANG Fang-ping;WENG Hai-yan(Department of Pathology,the First Affiliated Hospital of Science and Technology University of China,Hefei 230036,China;Clinical Pathology Center,Anqing First People’s Hospital,Anqing 246000,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)临床病理中心,合肥230036 [2]安庆市第一人民医院临床病理中心,安徽安庆246000

出　　处：《诊断病理学杂志》2021年第10期826-830,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨30例伴有术后不良复发的子宫平滑肌瘤的临床病理特征、诊断及预后。方法回顾性分析30例伴有术后不良复发的子宫平滑肌瘤病例,并选择96例经随访良性复发的病例(对照组)比较其临床病理学特征、免疫表型,复习相关文献,并对患者进行随访。结果术后不良复发为子宫平滑肌肉瘤(LMS)9例、恶性潜能未定的平滑肌肿瘤10例、转移性平滑肌瘤10例及静脉内平滑肌瘤病1例。初次手术方式为腹腔镜、复发次数≥2次、复发间隔时间≤3年在不良复发组更多见。术后复发为LMS的初次手术年龄≥40岁较良性复发组多见(P<0.05)。伴有术后不良复发的平滑肌瘤的组织学特点:细胞密度增加(92.9%),细胞核深染(100%),核分裂象1~6个/10HPF,肿瘤边界不规则(91%),出现裂隙样结构(100%)和厚壁血管(71%),间质伴玻璃样变(71%)、黏液样变性(57%)及局灶水肿(29%)、梗死(14%)。其中细胞核深染、肿瘤边界不规则较对照组多见。免疫组化检测不良复发组肿瘤组织SMA、Desmin、CD10的阳性率分别为100%、100%、14.3%、85.7%,Ki-67的表达范围2%~15%,平均5.47%。结论子宫平滑肌瘤组织学形态中细胞核深染、肿瘤边界不规则在术后不良复发组较多见,应注意加强随访。对于多次复发、复发时间间隔较短的患者,需警惕不良复发的可能性。Objective To investigate the clinical and pathological features,diagnosis and prognosis in 30 cases of uterine leiomyoma with postoperative adverse recurrence.Methods Thirty cases of uterine leiomyoma with postoperative adverse recurrence(adverse recurrence group)were retrospectively analyzed,and 96 cases with benign recurrence(control group)were selected to compare their clinical pathological features and immunophenotypes,the relevant literature was reviewed,and the patients were followed up.Results The pathology of postoperative adverse recurrence was uterine leiomyosarcoma(9 cases),smooth muscle tumors of uncertain malignant potential(10 cases),metastasizing leiomyoma(10 cases)and intravenous leimyomatosis(1 case).Laparoscopic approach for primary surgery,recurrence frequency≥2 times,and recurrence interval≤3 years were more commonly found in the adverse recurrence group.The recurrence of leiomyosarcoma was more commonly noted in the group with the age of first operation≥40 years than in the control group(P<0.05).Histologic features of leiomyoma with postoperative adverse recurrence included increased cell density(92.9%),hyperchromatic nuclei(100%),mitoses 1-6/10 HPF,irregular tumor boundaries(91%),fissure like structures(100%)and thick-walled vessels(71%),hyaline degeneration(71%),mucinous degeneration(57%),focal edema(29%),and infarction(14%)in the stroma.Hyperchromatic nuclei and irregular tumor boundaries were more commonly found in the adverse recurrence group than benign recurrence.Immunohistochemistry was used to detect the expression of SMA,Desmin and CD10 in the adverse recurrence group,in which positive rates were 100%,100%,and 14.3%respectively.The expression range of Ki-67 index was 2%-15%,with an average of 5.47%.Conclusion Hyperchromatic nuclei and irregular tumor boundaries are more commonly found in the group of postoperative adverse recurrence,and so more follow-up should be paid attention to those patients.For patients with multiple recurrences and short time interval of recurrence,the

关 键 词：子宫肿瘤 平滑肌瘤 预后 复发 免疫组织化学 

分 类 号：R737.33[医药卫生—肿瘤]