未分化子宫内膜肉瘤6例临床病理观察

Undifferentiated endometrial sarcoma:a clinicopathological analysis of 6 cases

目的探讨未分化子宫内膜肉瘤(undifferentiated endometrial sarcoma,UES)的临床病理特点、诊断及鉴别诊断。方法对6例未分化子宫内膜肉瘤的临床资料、组织学形态及免疫组化结果进行观察分析。结果患者年龄49～71岁,平均年龄59岁,临床主要表现为宫腔内占位和阴道出血;肿瘤大体呈息肉样,突入宫腔;镜下见肿瘤组织分化差,细胞异型明显,核分裂象丰富(>10个/10 HPF),坏死常见;免疫组化标记,肿瘤细胞CD10、ER、PR、desmin、SMA、CK、EMA阴性,vimentin、EGFR阳性;6例随访6个月～4年,3例死于肺转移。结论未分化子宫内膜肉瘤是一种少见的子宫内膜间质肿瘤,具有高度恶性。肿瘤组织分化差,细胞异型明显,常见坏死,免疫组化标记有助于诊断与鉴别。

Purpose To investigate the clinicopathological feature as well as the diagnosis and differential diagnosis of undifferentiated endometrial sarcoma.Methods Six cases of undifferentiated endometrial sarcoma were studied by clinical data analysis,histopathology and immunohistochemistry.Results The age of patients ranged from 49 to 71 years（median,59 years）.The major clinical manifestations were uterine masses and abnormal vaginal bleeding.Grossly,the tumors showed polypoid.On microscopic examination,they were composed of atypical cells with brisk mitotic activity（10/10 HPF）,and necrosis was present.Immunohistochemically,the tumor cells were negative for CD10,ER,PR,desmin,SMA,CK and EMA,and positive for vimentin and EGFR.The follow-up revealed that 3 patients died of lung metastases.Conclusions Undifferentiated endometrial sarcoma is a rare endometrial stromal tumor,with high aggressive behaviors.It is characterized by marked cellular polymorphism and frequent presence of necrosis.Immunohistochemistry is helpful for the diagnosis and differential diagnosis.