低度恶性子宫内膜间质肉瘤的病理表现

Low-grade malignant endometrial stromal sarcoma:a clinicopathological observation

目的:探讨低度恶性子宫内膜间质肉瘤(LESS)的临床病理学特征及其诊断和鉴别诊断。方法:对13例LESS患者的肿瘤组织标本进行光镜观察和免疫组化标记,并复习相关文献。结果:光镜下,13例LESS组织形态均显示肿瘤由弥漫性增生的内膜间质细胞组成,呈浸润性生长,平滑肌组织间隙内有灶状或片状瘤组织分布,可见簇状分布的子宫内膜螺旋小动脉血管,其中3例伴不同程度的平滑肌分化。免疫组化检测结果显示,13例标本中肿瘤细胞CD10和波形蛋白(vimentin)均阳性,孕激素受体(PR)阳性11例,雌激素受体(ER)阳性9例和抗平滑肌抗体(SMA)阳性3例,结蛋白(desmin)、CD34和F8均阴性。结论:LESS内膜间质细胞具多向分化的特点,使其呈现出多样的组织形态,需结合组织病理形态、免疫组织化学染色和临床资料对LESS进行诊断和鉴别诊断。

Objective To study the clinicopathological features, diagnosis and differential diagnosis of low-grade malignant endometrial stromal sarcoma （LESS）. Methods Thirteen cases of low-grade malignant endometrial stromal sarcoma were studied microscopically and immunohistochemically with review of literatures. Results Histologically, 13 cases of LESS were characterized by infiltrative and diffuse proliferation of endometrial stromal cells and there were islands or pieces of tumor cells in the interspace of muscles; cluster like distribution of endometrial spiral small artery was seen. Three tumors showed various degrees of smooth muscle differentiation. Immunohistochemically, tumor cells were stained for CD10 and vimentin in 13 cases, progesterone receptors（PR）in 11 cases, estrogen reeeptors（ER）in 9 cases and SMA in 3 cases, but was not stained for Desmin, FS, and CD34. Conclusions LESS is a rare tumor, and the endometrial stromal cells are heterogenous morphologically because of their multipotential differentiation characteristics. Diagnosis and differential diagnosis of LESS could be made by combined consideration of pathological features, clinical data and immunohistochemistry results.