子宫内膜上皮内肿瘤形态学诊断及PTEN蛋白表达情况

Morphological diagnosis of endometrial intraepithelial neoplasia and expression of PTEN

目的 探讨子宫内膜上皮内肿瘤（EIN）病理诊断标准及PTEN在子宫内膜病变中的表达情况。方法收集子宫内膜病变51例，按照EIN诊断标准复习切片重新诊断并与原诊断进行比较。同时做免疫组织化学PTEN（EnVision方法）染色，观察其表达情况。结果经重新诊断，2例原诊断单纯增生者有小灶EIN存在，3例原诊断不典型增生者不足EIN标准。增殖期子宫内膜、良性增生、EIN、子宫内膜样癌PTEN缺失率分别为50．0％（4／8）、50．0％（4／8）、66．7％（16／24）及81．8％（9／11）。各组缺失率差异无统计学意义（P=0．383）。结论EIN组织学诊断标准是可行的，但与传统应用的子宫内膜增生分类有一定的差别。PTEN缺失在诊断中有提示作用，但不能作为确定诊断的依据。

Objective To investigate the diagnostic applications of endometrial intraepithelial neoplasia （EIN）, and the expression of PTEN in endometrial lesions. Methods Fifty-one cases of endometrial lesions were enrolled in this study. Using diagnostic criteria of EIN, the diagnosis were made and compared with the original results. Immunohistochemistry for PTEN was performed in all cases. Results Two cases of simple hyperplasia originally diagnosed were reclassified as EIN. Three cases with atypia originally diagnosed showed no EIN pattern. PTEN deletion rates were 50. 0%, 50. 0%, 66.7% and 81.8% in proliferative endometrium, benign hyperplasia, EIN and endometrial carcinoma, respectively. Conclusions Diagnosis of EIN is applicable and its morphology and diagnostic criteria are different from the classical one （WHO94） for endometrial hyperplasia. Detection of PTEN deletion by immunohistochemistry is useful in identifving EIN. but cannot be used as an ultimate confirmin~ factor.