50例子宫内膜间质肿瘤临床病理分析

Clinicopathologic Analysis of Endometrial Stromal Tumours:A Report of 50 Cases

目的:探讨子宫内膜间质肿瘤的临床、病理及其多成分分化特点、鉴别诊断及预后。方法:分析50例子宫内膜间质肿瘤(子宫内膜间质结节6例、低度恶性子宫内膜间质肉瘤30例、未分化子宫内膜肉瘤11例、子宫内膜间质平滑肌混合瘤3例)的临床、病理、合并症、鉴别诊断及预后。结果:不同类型肿瘤均有部分病例伴多成分分化,(12例伴平滑肌分化、10例伴性索样分化、1例伴纤维分化、1例伴纤维粘液样分化、1例伴上皮样分化,其中10例同时伴两种分化成分)。50例中有9例伴发子宫平滑肌瘤(其中1例同时伴发腺瘤样瘤,1例伴发高分化子宫内膜腺癌)。结论:不同类型子宫内膜间质肿瘤均可伴发多成分分化及其他类型肿瘤,具备多样性病理形态特征,肿瘤有无浸润及肿瘤细胞异型程度、核分裂象数量是确定本瘤性质的必备条件。

Objective： To investigate the clinicopathologic features, multi-differentiation, differential diagnosis and the prognosis of endometrial stromal tumors. Methods： The clinicopathologic data （including the histological characteristics, histochemical and immunohistochemical staining features）, complication, differential diagnosis and the prognosis of endometrial stromal tumours were analyzed. Resuits： According to WHO Histological Typing of Female Genital Tract Tumours （2003）, 50 cases with endometrial stromal tumors （ESTs） were divided into the endometrial stromal nodule （6 cases）, （low grade） endometrial stromal sarcoma （30 cases）, undifferentiated endometrial sarcoma （11 cases）, mixed endometrial stromal and smooth muscle tumors （3 cases）. Various tumors presented with multi-differentiation： 12 cases with smooth muscle, 10 with sex cord, 1 with fibrous, 1 with fibro-mucoid, and 1 with epithelial differentiation. In 10 cases, there were two types of differentiation. Moreover, 9 cases were associated with leiomyoma, in which 1 was case associated with adenomatoid tumor and 1 with well-differentiated endometrial adenocarcinoma. Conclusions： All types of endometrial stromal tumor can display multi-differentiation and associated with other type of tumor. They show various pathomorphological features. Among them smooth muscle and sex-cord differentiation are the most common types. Leiomyoma is the most commonly associated tumour. Histochemical and immunohistochemical stains can help diagnosis and differential diagnosis. Ten cases showed 30% positive rate for CDll7, this may provide a theoretical basis for the molecular targeted-therapy to unresectable or mestastatic cases. There is no definite correlation between prognosis for the tumor and the types of multi-dlfferentiation components of ESTs. But the invasion of tumor, the degree of atypical cell and the amount of nuclear mitotic figure all are a prerequisite for determination of the nature of endometrial stromal tumors.