低级别子宫内膜间质肉瘤的临床诊治探讨

Clinical diagnosis and treatment of low-grade endometrial stromal sarcoma

为了探讨低级别子宫内膜间质肉瘤(LESS)的临床病理学特征、诊断和鉴别诊断,分析10例LESS的临床病理特点、网织纤维染色和免疫组化染色研究其病理学特征。结果显示,LESS临床上主要表现为阴道不规则流血;瘤细胞类似于增生期子宫内膜间质细胞,形态较一致,圆形或卵圆形,少数为短梭形,胞质较少,胞核圆形或不规则形,核染色质较细;肿瘤内有大量丛状生长的分支状小的、薄壁的血管,类似于子宫内膜的螺旋动脉,部分肿瘤血管透明变性呈星状或放射状结构;网织纤维染色见网状纤维丰富,围绕瘤细胞生长。肿瘤细胞8例CD10阳性,6例ER阳性,6例PR阳性,2例Actin阳性,CD34、CD117和Melan-A肿瘤细胞均阴性。初步研究结果提示,LESS易误诊为子宫内膜间质结节、未分化子宫内膜间质肉瘤、富于细胞性平滑肌瘤、静脉内平滑肌瘤病及血管周上皮样细胞肿瘤,确诊主要依靠组织病理学和免疫组织化学。

The objective of this study was to investigate the clinicopathologic characteristics and differential diagnosis of low grade endometrial stromal sarcoma.Ten cases of low grade endometrial stromal sarcoma were observed by histologic and immunohistochemical staining.The clinical manifestation of these patients was irregular vaginal bleeding.Microscopically,the tumor was densely cellar and composed of uniform,oval to spindle-shaped cells of endometrial stromal-type,and cellular atypia and pleomorphism were absent.A rich network of delicate small arterioles resembling the spiral arterioles of the late secretory endometrium supported the proliferating cells.Perivascular hyalinization and a stellate or starburst pattern of hyalinization occurred in some cases.Reticulin stains revealed a dense network of fibrils surrounding individual cells or small groups of cells.Immunohistochemically,8 cases were positive for CD10,6 cases for ER,6 cases for PR,2 cases for actin,and all cases were negative for CD34,CD117 and Melan-A.In conclusion,LESS is easily mistaken for other lesions.The differential diagnosis includes endometrial stromal nodule,undifferentiated endometrial sarcoma,cellular leiomyoma,intravenous leiomyomatosis,and perivascular epithelioid cell tumor.Histopathological and immunohistochemical findings are helpful in differential diagnosis.