17例子宫恶性中胚叶混合瘤临床病理特征及PRA、PRB蛋白表达及其意义

Clinicopathologic feature and PRA,PRB expressions of 17 cases uterine malignant mixed mesodermal tumor and their significannce

背景与目的:子宫恶性中胚叶混合瘤(malignant mixed mesodermal tumor,MMMT)是罕见的妇科恶性肿瘤,预后极差,是临床诊治的难点。本研究旨在探讨本病的临床、病理特征及孕激素受体亚型(progesterone receptor subtype A and B,PRA and PRB)蛋白在子宫MMMT的表达及其意义。方法:回顾性分析17例患者的临床资料,并对其病理切片行光镜观察并应用免疫组化法测定PRA、PRB的表达情况,随访其中的11例患者。结果:①子宫MMMT表现缺乏特异性,主要表现为阴道出血。②病理上肿瘤成分复杂,形态多样,有上皮和间叶两种成分组成,相互间有穿插和移行变化。③同源性PRA阳性占55.6%,PRB阳性占33.3%;异源性PRA阳性占37.5%,PRB阳性占37.5%,两种亚型间差异无显著性(P>0.05)。PRA在Ⅰ期和Ⅱ期患者的表达率分别为66.7%和40%;PRB患者分别为55.6%和20%。④Ⅰ期患者平均存活43.8个月(32～59个月),Ⅱ期平均存活34.25个月(19～41个月);Ⅲ期1例,存活5个月。结论:子宫MMMT的诊断主要依赖组织形态学,疾病进展可能与PRA、PRB的丢失有关,PRA、PRB的表达可能与病理类型无关。预后可能与临床分期及PRA、PRB的表达有关。

Background and purpose：MMMT is known as a rare malignancy in gynecological tumor. Because of its difficulty in diagnosis and treatment, the prognosis is extremely poor. This study was to discuss the clinicopathologic feature and PRA,PRB expressions of uterine MMMT. Methods：We analysed clinicopathologic data and the expressions of PRA,PRB by immunohistochemical staining on 17 cases of uterine MMMT, and 11 patients were followed up. Results：①The patients usually presented with abnormal vaginal bleeding with no specifi city clinically. ②The morphological changes were various and complicated, including epithelial and mesenchymal components and a variety of inter-permeated and transitional tissue elements.③The positive rate of PRA in stageⅠ and stageⅡ were 66.7% and 40%, and PRB in stage Ⅰ and stageⅡwere 55.6% and 20%, respectively. ④The mean survival time in stageⅠ,Ⅱ and Ⅲ were 43.8 months （32-59）, 34.25 months （19~41） and 5 months, respectively. Conclusion：The diagnosis of uterine MMMT was mainly based on tissue morphology; the development of uterine MMMT might be related with the loss of PRA and PRB ; the clinical stage and the expression of PRA and PRB might be the prognostic factors for uterine MMMT.