子宫内膜不典型息肉状腺肌瘤5例临床病理分析

Atypical polypoid adenomyomas of uterus:a clinicopathologic study of 5 cases

目的探讨子宫内膜不典型息肉状腺肌瘤（atypical polypoid adenomyomas，APA）的临床与病理学特点。方法分析5例APA的临床资料、病理学形态、免疫组化标记及4例随访资料。结果5例APA中，1例合并子宫内膜样腺癌，1例局部分布分化良好的腺癌成分；免疫组化显示：间质SMA（＋），desmin（＋）或局部（＋），vimentin局部（＋）或（-）；腺上皮ER、PR均（＋）；p53、Ki-67（-）。随访的4例患者均健在（3—60个月）。结论APA需与高分化的子宫内膜样腺癌鉴别，后者可与APA并存，或起源于子宫内膜不典型息肉状腺肌瘤，具有低恶性潜能和潜在的复发性，长期随访十分必要。

Purpose To explore the clinical and pathological characteristics in atypical polypoid adenomyomas （ APA ） of the uterus. Methods Clinical data, pathological examination, immunohistochemical staining were analyzed and studied in 5 cases of APA, with follow-up in 4 cases. Results In the 5 cases, one was diagnosed as APA accompanied by endometrial carcinoma, and one had local well-differentiated endometrial carcinoma component in APA. Immunohistochemically, the stromal cells in all of the 5 APA cases revealed a positive staining for desmin and SMA, negative or focal positive for vimentin ; all of the cases showed prominent staining of the glandular epithelia with estrogen receptor and progesterone receptor proteins, Both the stromal cells and the glandular epithelia were negative staining for p53 and Ki-67. 4 cases with follow-up were all survival for 3 ～ 60 months after diagnosis. Conclusions The major differential diagnosis from APA is the well-differentiated endometrioid carcinoma. APA can be accompanied by endometrioid carcinoma, and the latter may originate from the APA. APA has a low malignant potential with high risk of recurrence. Therefore, long-term follow-up is suggested for APA patients.