低度恶性子宫内膜间质肉瘤分化特性探讨

Study on the differentiation characteristic of low-grade endometrial stromal sarcoma

目的探讨低度恶性子宫内膜间质肉瘤（LGESS）分化特性与病理诊断、鉴别诊断。方法应用免疫组化染色对11例LGESS进行Vim、CD10、ER、PR、CD99、Iinhibin、CK、EMA、Des、SM、CD117、CD34等抗体成分检测，分析瘤组织分化特性与病理诊断、鉴别诊断关系。结果临床表现停经后阴道流血6例，月经增多3例、下腹痛2例。肿瘤直径2-10cm，6例息肉样突入宫腔，5例肌间结节状。镜下瘤组织由梭形细胞构成，弥漫束状排列，类似正常增殖期子宫内膜间质细胞，呈舌状浸滑性生长，可见丛状分布薄壁螺旋动脉样血管，核分裂数〈10个／10HPF，可见泡沫细胞。伴有平滑肌、性索样分化各3例，经典型、腺样分化各2例，混合型1例。免疫组化：Vim（11／11）、CD10（10／11）、PR（8／11）、ER、SM（7／11）、CK（6／11）、EMA、Des、S-100（3／11）、CD99、Iinhibin（2／11）、CD117、CD34、LCA均阴性。结论LGESS是一种以梭形细胞为主，类似增殖期子宫内膜间质细胞肿瘤，可以向平滑肌、性索样等组织分化。多向分化特性致使瘤组织形态易误诊为平滑肌肿瘤、低分化子宫内膜腺癌。结合临床，免疫组化有助于病理诊断。

Objective Discusses between the low-grade endometrial stromal sarcoma（LGESS） differen- tiation characteristic and the pathological diagnosis, the differentiate diagnosis. Methods The application immuno- histochemical on immune body ingredient examinations and so on the Vim, CD 10, ER, PR, CD99, Inhibin, CK, EMA, Des, SM, CD117, CD34 to 11 example LGESS, the analysis lump tissue differentiation characteristic and the pathological diagnosis, the differentiate diagnosis relations. Results After the clinical manifestation menopause the vagina bleeds 6 examples, the menstruation increases 3 examples, the hypogastralgia 2 examples.The tumor diameter 2cm-10cm, 6 example polyp type penetrates the palace cavity, 5 example intermusculars tie the nodular.Under the mirror the lump organization by the spindle-shaped cell constitution, fills the air ties the shape arrangement, the similar normal period of growth endometrium intersititial cell, assumes the tongue wetting quality tO grow, the obvious fasciculate distribution thin wall spiral artery type blood vessel, the nuclear fission counts 〈 10/10HPF, obvious froth cell.Is accompanied by the smooth muscle, the rope type splits up each 3 examples, after the model, the adenoid splits up each 2 examples, the mixed 1 example.Immunohistochemistry Vim（11/11）, CD10（10/11）, PR（8/11）, ER, SM （7/11）, CK（6/11）, EMA, Des, S-100（3/11）, CD99, Inhibin（ 2/11 ）, CD117, CD34, LCA even negative. Conclusions LGESS is one kind by the spindle-shaped cell primarily, the similar period of growth endometrium intersititial cell tumor, may to the smooth muscle, tissue differentiations and so on rope type.Many easy to misdiagnose to the split up characteristic cause lump organization shape for the smooth muscle tumor, the low score beggar palace internal membrane gland cancer.Unifies clinically, the immunohistochemical stain is helpful to the pathological diagnosis.