子宫内膜息肉恶变38例临床病理特征分析  

Endometrial Carcinoma Arising in Endometrial Polyps:a Clinicopathologic Review of 38 Cases

作　　者：徐炜[1] 王湘炼 陈醒 张林[1] 程文俊[1] XU Wei;WANG Xianglian;CHEN Xing(Department of Gynecology,The First Affiliated Hospital of Nanjing Medical University,Nanjing Jiangsu 210029,China)

机构地区：[1]南京医科大学第一附属医院妇科,江苏南京210029

出　　处：《实用妇产科杂志》2025年第1期66-70,共5页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨来源于子宫内膜息肉(EP)恶变的子宫内膜癌的临床病理特征。方法:收集2010年1月至2021年12月在南京医科大学第一附属医院妇科行手术治疗,并经病理证实由EP恶变的38例子宫内膜癌患者的临床病理资料,从肿瘤病理类型、患者绝经状态及恶变病灶范围三个维度进行分析。结果:①肿瘤病理类型中,EP恶变的子宫内膜样癌33例(86.8%),浆液性癌5例(13.2%),前组患者平均年龄显著小于后组(53.3±10.0岁vs.63.4±10.3岁,P=0.043)。②绝经状态中,绝经前、后组中由非典型息肉样腺肌瘤(APA)恶变者分别为10例(55.6%)、1例(5.0%),差异有统计学意义(P=0.001);绝经前患者术后补充治疗率显著低于绝经后患者(16.7%vs.50.0%,P=0.043)。③恶变范围局限于息肉、累及息肉周边内膜两组患者的年龄、绝经状态、体质量指数(BMI)、合并症、异常子宫出血、息肉最大径、肿瘤分期、分级、治疗方式及复发率差异均无统计学意义(P>0.05)。结论:来源于EP恶变的子宫内膜样癌、浆液性癌分别多见于围绝经期、绝经后患者。EP恶变的绝经前患者中,约半数肿瘤为APA恶变,分化程度较高,术后补充治疗率低。Objective:To investigate the clinicopathological features,treatment and prognosis of endometrial carcinoma arising in endometrial polyps(EPs).Methods:Thirty-eight cases of endometrial carcinoma arising in EPs were collected in the First Affiliated Hospital of Nanjing Medical University from January 2010 to December 2021.The clinical data,pathological characteristics,and follow-up information were retrospectively analyzed from three dimensions:tumor histological type,the menopausal status of the patients and the scope of malignant lesions.Results:①In terms of tumor histological type,uterine endometrioid carcinoma 33 cases(86.8%)and uterine serous carcinoma 50 cases(13.2%),the mean age of patients with endometrioid carcinoma arising from EPs was significantly lower than that of patients with serous carcinoma arising from EPs(53.3±10.0 years vs.63.4±10.3 years,P=0.043).②In terms of menopausal status,endometrioid carcinoma progressed from atypical polypoid adenomyoma(APA)accounted for 55.6%(10/18)and 5.0%(1/20)in the pre-and post-menopausal group,respectively(P=0.001).The rate of adjuvant therapy was significantly lower in premenopausal patients than in postmenopausal patients(16.7%vs.50.0%,P=0.043).③There were no significant differences in patients age,menopausal status,BMI,comorbidities,abnormal uterine bleeding,maximum diameter of EP,tumor stage,grade,treatment or recurrence rate between cases with tumors confined and unconfined to EPs.Conclusions:Endometrioid and serous carcinomas progressed from EPs were more common in perimenopausal and postmenopausal patients,respectively.Malignancies derived from APA contributed to almost half of EP-arising carcinomas in premenopausal women,with a higher degree of differentiation and a low rate of postoperative adjuvant therapy.

关 键 词：子宫内膜肿瘤 子宫内膜息肉 非典型息肉样腺肌瘤 恶变 临床病理 

分 类 号：R737.33[医药卫生—肿瘤]