子宫腺瘤样瘤49例临床病理分析

Adenomatoid tumors of the uterus: a clinical pathological study of 49 cases

目的 探讨子宫腺瘤样瘤的组织发生、临床病理特点及鉴别诊断。方法 分析 4 9例子宫腺瘤样瘤临床病理学资料 ,其中 14例行特殊染色和免疫组化染色。结果 4 9例子宫腺瘤样瘤占同期子宫标本的 1 3% ,肿瘤多位于子宫肌壁间 ,其次为近子宫角和宫体或宫底浆膜下 ,内膜下少见。肿瘤直径 0 5～ 5cm ,临床表现无特征性。瘤细胞组成形态不一的腺样及腔隙样结构 ,腔隙内衬以扁平或立方上皮细胞 ,大多数表现为脉管样形态。全部病例均伴平滑肌增生。 14例腔隙内黏液物AlicianBlue染色阳性 ,PAS染色阴性。免疫表型 :不同类型CK、vimentin、SMA及calretinin阳性 ,FⅧRAg、CEA、EMA、ER及PR阴性。结论 子宫腺瘤样瘤并非罕见 ,临床和病理上均易误诊和漏诊。瘤细胞表达CK和calretinin ,不表达FⅧRAg、CEA和EMA ,上述指标对子宫腺瘤样瘤的诊断和鉴别诊断均具有重要意义。本组研究结果也支持子宫腺瘤样瘤为间皮来源。

Purpose To study the histogensis the clinicopathological characteristics and the differential diagnosis of adenomatoid tumors in uterus. Methods The clinical and pathological data of 49 cases of adenomatoid tumors in uterus were analyzed, of which 14 cases were marked by histochemical and immunhistochemical staining. Results 49 cases of adenomatoid tumors of uterus were diagnosed accounting for 1.3% of all hysterectomy for same period. Most of them located in the uterine muscle walls, some was in the cornuas and the under serosa. A few was under endometrium. The masses ranged from 0.5 to 5 cm in size. The clinical characteristics were not appearant. Microscopically, the tumor consisted of various gland-like or vessel-like patterns. Luminal spaces lined with flat, cuboidal cells. Of the 49 cases, 38 cases were canalicular type. All cases shown smooth muscle cells hyperplasia. 14 cases showed Alician blue staining positive, but negative for PAS staining. Immunohistochemical staining showed that tumor cells were positive for different type CK, vimentin, SMA and calretinin, but negative for FⅧRAg, CEA, EMA and PAS. Conclusions Adenomatoid tumors were not very rare in the uterus. Misdiagnosis of the tumors usually occurred clinically and pathologically. Alician Blue、CK、vimentin、SMA and calretinin positive staining are helpful for diagnosis. Other tumors similar to this tumor can be exclude by negativity for FⅧRAg、CEA、EMA and PAS staining. These results also support this tumor is from mesothelium in origin.