40岁以下妇女子宫内膜癌刮宫活检的病理诊断问题

Pathologic diagnosis of endometrial carcinoma in curettage specimens in women under forty years of age

目的 探讨40岁以下妇女子宫内膜癌刮宫活检的病理诊断。方法 对20例40岁以下子宫内膜癌患者的临床病理资料进行回顾性分析。结果 子宫内膜样腺癌18例,腺鳞癌(腺癌伴鳞状上皮分化)1例,浆液性乳头状癌并透明细胞癌1例。子宫内膜样腺癌的组织学特点是子宫内膜腺体失去极性,细胞核变大、变圆、核仁突出,染色质粗或呈空泡状,同时子宫内膜间质消失,代之为肉芽组织或纤维组织,常有炎性反应。子宫内膜样腺癌多数仅累及浅肌层,皆无转移。1例子宫内膜腺鳞癌呈双侧卵巢转移; 1例浆液性乳头状癌有盆腔淋巴结转移。结论 40岁以下妇女的子宫内膜癌多数为高分化子宫内膜样腺癌,应注意与子宫内膜不典型增生及不典型息肉状腺肌瘤鉴别。

Objective To investigate the diagnostic pathological features of endometrial carcinomas present in women under 40 years of age (by curettage samples). Methods A retrospective analysis was performed on 20 cases of endometrial carcinomas in women under 40 years of age. Results The patients included 18 endometrioid adenocarcinoma cases, one adenosquamous carcinoma case, and one papillary serous carcinoma case. The morphological features of the endometrial adenocarcinoaare loss of polarity (orientation) of the endometrial glands. The tumor cells have large round vesicular nuclei, prominent nucleoli and coarse chromatin. In additon, endometrial stroma was instead of by the fibrous and/or granulation tissue type stroma, usually with inflammatory response. Majority cases of endometrioid adenocarcinomas had superficial invasion of myometrium and no lymph node metastasis. The adenosqua- mous case metastasized to the ovaries and the papillary serous carcinoma case metastasized to the pelvic lymph nodes. Conclusions Endometrial carcinomas which are highly differentiated endometrioid adenocarcinomas occur frequently in women under 40 years of age. An important differential diagnosis of the endometrioid carcinoma in a curettage specimen is to differentiate it from atypical endometrial hyperplasia and atypical polypoid adenomyoma.