子宫和输卵管腺瘤样瘤临床病理分析

Adenomatoid tumor of uterus and fallopian tube： a clinicopathological analysis of 33 cases

目的探讨子宫和输卵管腺瘤样瘤的发生，临床病理特点，免疫组化表达特征及鉴别要点。方法对33例腺瘤样瘤进行临床病理及免疫组化观察。结果33例腺瘤样瘤，31例发生于子宫，2例发生于输卵管，肿瘤多位于浆膜下及近浆膜的肌壁间。其中1例妊娠患者肿瘤弥漫性生长伴梗死，32例呈结节状生长，结节直径1－5cm不等。临床表现无特征性，本组33例子宫腺瘤样瘤中合并子宫平滑肌瘤19例（57．6％），腺肌症6例（18．2％），既有平滑肌瘤又有腺肌症2例（6．1％），合并子宫平滑肌瘤和卵巢畸胎瘤2例（6．1％），卵巢畸胎瘤2例（6．1％），只有3例仅表现为腺瘤样瘤（9％）。2例输卵管腺瘤样瘤中分别合并有卵巢子宫内膜异位囊肿、宫颈大细胞癌合并输卵管子宫内膜异位症。镜下，肿瘤由大小不等，形态不一的腺腔样结构组成，周围可见增生的平滑肌。免疫组织化学结果：在33例腺瘤样瘤中，所有病例腺腔样成分均呈现CK（100％）及Calretinin（100％）阳性，CD34阴性（0％），其中20例同时进行EMA染色，仅10例呈阳性表达（50．0％）。其鉴别诊断主要包括：平滑肌瘤或腺肌瘤、印戒细胞癌和低分化腺癌、血管平滑肌瘤及淋巴管瘤。结论女性生殖系统腺瘤样瘤为间皮起源，子宫为最常见部位。免疫组化染色对于腺瘤样瘤诊断及鉴别诊断具有帮助。其生物学行为为良性，预后好。

Objective To study the oncogensis, the clinical pathological characteristics, the immunohistochemical feature and the differential diagnosis of adenomatoid tumors in uterus and fallopian tube. Methods Clinical pathological analysis, histochemical and immunohistochemical studies were performed in 31 cases of adenomatoid tumor in the uterus and 2 case in fallopian tube. Results 32 cases of adenomatoid tumors of the uterus and fallopian tube were diagnosed. 29（87.9%） cases were located in the sub-serosa or near to serosa, and 4（12.1%） case was located in the myometrium.1 case was of diffuse type, and 32 cases were of solitary type. The nodules ranged from 1-5cm in size. The clinical characteristics were not obvious. It can occur simultaneously with uterus leiomyoma in 19 cases （57.6%）, adenomyosis in 6 case （18.2%）, with uterus leiomyoma and adenomyosis in 2 cases （6.1%）, with uterus leiomyoma and teratoma of ovary in 2 cases （6.1%）, with teratoma of ovary in 2 cases （6.1%）. Only 3 cases was presented with adenomatoid tumors （9%）.Two cases occurred in fallopian tube complicated with ovarian endometriosis, large cell carcinoma of cervix and endometriosis of fallopian tube, respectively. The cut surface presented a nodular pattern with grayish white or yellowish in color, partially micro cystic. Microscopically, the tumor contained tubular or glandlike structures lined by cuboidal or flattened cells. The former structures were separated by a variable thickness of muscle fibers. Immunohistochemical staining showed that tumor cells in 33 cases were positive for Calretinin （100%） and CK （100%）, negative for CD34 （0%）. The 10 cases tested by immunohistochemistry in 20 cases reacted with EMA （50.0%）. The differential diagnosis potentially inciudes uterus leiomyoma or adenomyoma, signet ring cell carcinoma and low differentiated adenocarcinoma, vascular leiomyoma, as well as lymphangioma. Conclusions Adenomatoid tumors of the uterus and fallopian tube were benign, rare lesions of the genital tract, and of mesothelial origin. The uterus was the most common site followed by the fallopian tubes. Clinically, it was often misdiagnosed. Immunohistochemical staining is helpful for diagnosis and differential diagnosis.