伴间质细胞增生、玻璃样变性及索状结构的子宫内膜样腺癌1例  

Endometrioid adenocarcinoma with proliferated stromal cells,hyalinization and cord-like formations:A case report

作　　者：宁博涵 张青霞 杨慧 董颖[1] NING Bo-han;ZHANG Qing-xia;YANG Hui;DONG Ying(Department of Pathology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院病理科,北京100034

出　　处：《北京大学学报（医学版）》2023年第2期366-369,共4页Journal of Peking University:Health Sciences

摘　　要：子宫内膜样腺癌存在多种形态学变型,为临床病理诊断工作带来挑战。伴索状结构及玻璃样变性的子宫内膜样腺癌(corded and hyalinized endome-trioid carcinomas,CHEC),是一种少见的形态学变型,呈现双向分化的形态学特点,易与癌肉瘤相混淆,但此类肿瘤多数分期较早,患者在子宫切除术后预后良好。本文报道1例CHEC,并结合既往研究中此种内膜癌相关临床病理特点及分子特征进行分析总结,以进一步深入认识其形态变型,避免日常工作中的过度诊断。Corded and hyalinized endometrioid carcinoma(CHEC)is a morphologic variant of endo-metrioid adenocarcinoma.The tumor exhibits a biphasic appearance with areas of traditional low-grade adenocarcinoma merging directly with areas of diffuse growth composed of epithelioid or spindled tumor cells forming cords,small clusters,or dispersed single cells.It is crucial to distinguish CHEC from its morphological mimics,such as malignant mixed mullerian tumor(MMMT),because CHECs are usually low stage,and are associated with a good post-hysterectomy prognosis in most cases while the latter portends a poor prognosis.The patient reported in this article was a 54-year-old woman who presented with postmenopausal vaginal bleeding for 2 months.The ultrasound image showed a thickened uneven echo endometrium of approximately 12.2 mm and a detectable blood flow signal.Magnetic resonance imaging revealed an abnormal endometrial signal,considered endometrial carcinoma(StageⅠB).On hysterectomy specimen,there was an exophytic mass in the uterine cavity with myometrium infiltrating.Microscopically,most component of the tumor was well to moderately differentiated endometrioid carcinoma.Some oval and spindle stromal cells proliferated on the superficial surface of the tumor with a bundle or sheet like growth pattern.In the endometrial curettage specimen,the proliferation of these stromal cells was more obvious,and some of the surrounding stroma was hyalinized and chondromyxoid,which made the stromal cells form a cord-like arrangement.Immunostains were done and both the endometrioid carcinoma and the proliferating stroma cells showed loss of expression of DNA mismatch repair protein MLH1/PMS2 and wild-type p53 protein.Molecular testing demonstrated that this patient had a microsatellite unstable(MSI)endometrial carcinoma.The patient was followed up for 6 months,and there was no recurrence.We diagnosed this case as CHEC,a variant of endometrioid carcinoma,although this case did not show specificβ-catenin nuclear expression that was reported

关 键 词：子宫内膜样腺癌 临床病理学 诊断 间质细胞 玻璃样变性 

分 类 号：R737.33[医药卫生—肿瘤]