非典型子宫内膜异位症163例临床病理分析

Atypical endometriosis： a clinicopathologic study of 163 cases

目的探讨非典型子宫内膜异位症（AEM）的临床病理特点及其与肿瘤性病变的关系。方法对2004年1月-2006年12月天津市中心妇产科医院病理科的163例AEM标本进行临床与病理资料的回顾性分析，观察其腺上皮、间质与背景组织的病理学改变，以及伴发的肿瘤性病变。结果163例AEM占同期子宫内膜异位症（EM）的4．38％（163／3724）。172例次AEM中，168例次发生于卵巢，4例次发生于输卵管、宫颈及子宫浆膜。卵巢AEM的发生率为6．81％（161／2363），共26例（15．95％）、27例次AEM伴发同侧卵巢肿瘤，15例次（56％）为恶性，9例次（33％）为交界性，3例次（11％）为良性。AEM的上皮细胞主要以表面上皮细胞形式排列，镜下表现为中、重度细胞异型，上皮细胞拥挤，形成簇状与芽状突起。AEM病灶的囊壁由上皮、子宫内膜样间质与纤维胶原3层组成，子宫内膜样间质通常较薄，纤维胶原则较厚，伴瘢痕化背景。15例AEM伴发的恶性肿瘤中，14例（93％）可见AEM与肿瘤组织的移行。结论AEM兼具EM与肿瘤组织的部分特征，有更大的肿瘤倾向与恶变潜能，EM病灶经历的长期损伤与修复可能参与EM向AEM发展并衍化为肿瘤的过程。

Objective To investigate the clinicopathologic features of atypical endometriosis（AEM） and to discuss the relationship between AEM and tumors. Methods A retrospective analysis was performed of 163 cases of AEM, which were retrieved from the Department of Pathology files at the Tianjin Central Obstetrics and Gynecology Hospital between Jan 2004 and Dec 2006. The pathologic changes of AEM including its glandular epithelium, stroma, background and the conditions coexisting with tumor were observed. Results The AEM accounted for 4.38% （163/3724） of the endometriosis （EM） cases. Of 172 AEM foci of 163 patients, 168 were in the ovary, and the other 4 were in the fallopian tube, cervix and uterine serosa respectively. The rate of ovarian AEM was 6.81% of endometriosis. AEM associated with tumour was found in 26 cases （ 15.95% ） and among 27 of ovarian AEM, 15 were malignant, 9 borderline and 3 benign. The AEM epithelia were mainly arranged in the form of surface epithelium. They present with characteristic features of moderate to marked pleomorphism, epithelial tufting and bud structures by microscopy. The walls of AEM cyst were presented with three layers of epithelium, endometrioid stroma and fibrosis-collagen. The endometrioid stroma were usually thin in contrast to the fibro-collagen tissue, which was often thick with scarred background. The transformation from AEM to tumor was found in most of the malignant tumors（ 14/15,93% ）. Conclusions AEM lesions hold some features of both EM and tumor, which may have a relatively higher potential for tumorigenesis and canceration. The process of damage and repair in EM foci during a long course may play a role in the development of EM into AEM and finally into tumor.