子宫内膜间质肉瘤的形态学及免疫组化研究

Study of immunohistochemistry and morphology of endometrical stromal sarcoma

目的探讨子宫内膜间质肉瘤(ESS)的组织形态学及免疫组化特点。方法应用光镜、透射电镜观察46例ESS瘤体标本,并用SP法标记Vim、CK、Des、SMA、EMA、S-100、LCA、CD34、ER和PR。结果光镜下ESS组织由浸润性、弥漫性增生的单一性圆形或短梭形细胞组成,核分裂数<10个/10HP,间质小血管丰富,存在泡沫细胞浸润;电镜观察显示,瘤细胞超微结构近似正常子宫内膜间质细胞,具有纤维母细胞和平滑肌细胞的分化特点。免疫表型:肿瘤细胞Vim、CD10、ER(22/46)、PR(33/46)、EMA(22/46)和Des(22/46)阳性,CK、SMA、S-100、CD34和LCA均阴性。结论形态学和免疫组化表达特征提示ESS来自子宫内膜间质细胞,并具有向平滑肌、纤维母细胞和上皮细胞分化的特点。ESS对激素的敏感性可能与细胞的分化程度有关。

Objective It is to explore the characteristic of immunohistochemistry and morphology of endometrical stromal sarcoma （ESS）. Methods 46 cases of tumor body specimen of ESS were observed by light microscope and transmission electron microscope, and Vim, CK, Des, SMA, EMA, S- 100, LCA, CD34, ER and PR were marked by SP method. Results Light microscope showed that the ESS tissue was characterized by an infiltrative and diffuse proliferation of uniform round or oval cells, with abundant small blood vessels in stroma and vascular invasion of foam cells. The number of karyokinesis was〈 10/HP. Electron microscope showed that tumor cells whose ultrastructure were similar with that of normal proliferative phase endometrial cells had the differentiation of smooth muscle and fibroblast cells. Immunophenotype; Vim, CD10, ER（22/46）, PR（33/46）, EMA（22/46） and Des（22/46） of tumor cells were positive, and CK, SMA, S- 100, CD34 and LCA were negative. Conclusion The characteristics of immunohistochemistry and morphology show that ESS originates from endometrial stromal cells and has a potential for smooth muscle, fibroblast and epithelial cell differentiation. Hormonal sensitivity of ESS may be related with the differentiation degree of cells.