子宫内膜移行细胞癌临床病理学观察

Transitional cell carcinoma of the endometrium: a clinicopathological study of 3 cases

目的观察子宫内膜移行细胞癌(transitional cell carcinoma of the endometrium,ETCC)的临床病理特点,探讨其病理诊断、组织发生、生物学行为及预后。方法采用光镜、免疫组化对3例ETCC进行病理观察,并复习相关文献。结果3例ETCC患者均表现为绝经后不规则阴道流血。大体上,肿瘤呈息肉状生长伴浅肌层浸润。镜下,肿瘤表现为乳头状结构,乳头表面覆盖多层异型上皮细胞,中央为纤维血管中心柱,其周围肿瘤细胞呈单层栅栏状排列,乳头表面细胞呈扁平状。乳头内可见腺样结构,部分乳头呈实性团状排列,中央见大片坏死。肿瘤细胞大小相对较一致,核呈圆形、卵圆形,核膜明显,染色质呈空泡状,未见核沟,核中度异型,核分裂象15～20/10HPF。浸润肌层的为分化差的巢状移行细胞成分。除了主要TCC成分外,2例分别混合有透明细胞癌及内膜样型腺癌。免疫组化染色结果示肿瘤细胞CK7+、CK20-。结论ETCC是一种少见的子宫内膜癌的组织学亚型,形态学上具有尿路移行上皮分化特征,但保持了苗勒管的免疫表型CK7+/CK20-。诊断ETCC的关键在于认识移行细胞的形态学特征。

Purpose To explore the clinicopathological features of primary transitional cell carcinoma of the endometrium （ETCC） and its diagnosis, histogenesis, behaviour and prognosis. Methods The histological features and immunohistochemical characteristics were investigated by light microscopy in 3 cases of ETCC and the related literature was reviewed. Results The three patients presented with postmenopausal abnormal bleeding. Macroscopically, the tumors were polypoid and invaded the inner one-half of the myometrium. Microscopically, the tumor was composed of papillary structures with slender fibrovascular cores and covered by muhilayered atypical epithelial cells. The tumor cells adjacent to the fibrovascular cores were surrounded by a layer of palisaded cells. The cells coverng the surface of the papillary had a tendency to be fiat. Grandular differentiation was restricted to a few small areas of muhilayered epithelial cells. The tumor showed a solid papillary component which had central necrosis. The tumor cells had relatively uniform round, oval nuclei with prominent nuclear membrane and vesicular chromatin. Nuclear grooves were not observed. Nuclea atypia was moderate and mitotic activity was 15 to 20 per 10 high-power fields. The nests of poorly differentiated transitional epithelium invaded the myometrium. In additional to the dominant TCC, two cases were admixed with other histologic patterns, including clear cell and endometrioid patterns. The tumor cells were positive for CK7, but negative for CK20. Conclusions ETCC is a rare, distinct subtype of endometrial carcinoma with morphologic features of urothelial differentiation, but retention of mullerian immunoprofile CK7 ＋/CK20 -. The key point in the diagnosis of transitional cell carcinoma in the endometrium is the recognition of the transitional cell pattern by applying strict morphologic criteria.