子宫内膜间质肉瘤的临床病理和免疫组织化学分析

Clinicopathologic and immunohistochemical analysis of endometrial stromal sarcoma

目的:探讨子宫内膜间质肉瘤(endometrial stromal sarcoma,ESS)的临床病理及免疫组织化学特点及其在鉴别诊断中的意义。方法:采用HE和免疫组化SP法对20例ESS和10例子宫高度富于细胞平滑肌瘤(highly cellularleiomyoma,HCL)进行组织病理学及免疫组化对比分析。结果:ESS瘤细胞与增殖期子宫内膜的间质细胞相似;HCL瘤细胞呈圆形、梭形,可见大的厚壁血管。免疫组化染色,ESS瘤细胞CD10、SMA、MSA及Desmin的阳性率分别为100%、30%、20%及25%,而HCL相应的阳性率则为20%、100%、100%及100%。这些抗体在两组肿瘤间的表达差异有统计学意义,P<0.001。结论:ESS具有特殊形态特点,有向平滑肌分化的能力。CD10、SMA、MSA及Desmin的联合应用是鉴别ESS与HCL有用的免疫组织化学标志,CD10蛋白是一种相对特异的子宫内膜间质标记物,在子宫肿瘤中可以区别ESS和HCL。

OBJECTIVE： To study the clinicopathological characteristics and immunohistochemistry phenotype of endometrial stromal sarcoma （ESS）, and their clinical significance for the differential diagnosis between ESS and highly cellular leiomyoma （HCL）. METHODS： Twenty cases of ESS and ten cases of HCL of uterus were studied by means of the routine HE staining and SP immunohistochemical method. RESULTS： Microscopically, the tumor cell of ESS resembled the endometrial stromal cells in the proliferative phase and the helical arterioles were often observed. Whereas, HCL comprised rich cells with multiple shapes ranged from round to spindle. Blood vessels character ized by large, thick muscular walls were a prominent manifestation in majority of the tumors. Immunohistochemically, neoplastic cells of ESS demonstrated positivity for CD10 （100%）, SMA （30%）, MSA （20%）, and Desmin （25%）, respectively, while the positive rates of HCL for the corresponding markers were 20%. 100%, 100% and 100%, respectively. The differences between ESS and HCL were detected for all of the immunohistochemical markers （P〈0.01）. CONCLUSION： ESS possesses the special morphological features with the potential of smooth muscle differentiation. The combined application of SMA, MSA, and Desmin is great helpful for the differential diagnosis of ESS versus HCL and, of those antigens, CD10 is a relatively particular immunohistochemical marker for the differentiation.