78例子宫肉瘤临床病理分析

The Clinical-pathological features in 78 cases of uterine sarcoma

目的探讨不同组织学类型的子宫肉瘤临床病理特点。方法应用形态学观察及免疫组织化学染色回顾性分析78例子宫肉瘤临床及病理特点,并复习相关文献。结果 (1)78例子宫肉瘤中癌肉瘤35例(44.9%)、平滑肌肉瘤25例(32.1%)、子宫内膜间质肉瘤16例(20.5%)、腺肉瘤2例(2.6%)。(2)35例癌肉瘤,患者年龄16-75岁,平均年龄57.3岁。肿瘤多位于宫腔内(27例,77.1%)。肉瘤成分中含有同源性成分32例(91.4%),含有异源性成分3例(8.6%)。病理分期以I期最多(21例,60%)。(3)25例子宫平滑肌肉瘤,患者年龄31-61岁,平均年龄46.2岁,肿瘤位于宫腔9例(36%),肿瘤位于肌壁间7例(28%),病理分期I期最多(17例,68%)。(4)16例子宫内膜间质肉瘤,年龄25-59岁,平均年龄48.9岁,低度恶性子宫内膜间质肉瘤12例,年龄28-56岁,平均年龄42.3岁,未分化子宫内膜间质肉瘤4例,年龄52-58岁,平均年龄54.7岁,6例宫腔内肿瘤伴有肌壁内浸润(37.5%),子宫内膜间质肉瘤病理分期I期最多(11例,68.8%)。(5)2例子宫腺肉瘤,1例患者年龄40岁,肿瘤位于子宫腔内,病理分期为I期,另1例患者年龄35岁,肿瘤位于宫颈,病理分期为II期。结论 78例子宫肉瘤中以癌肉瘤最常见,发病年龄较大,其次为子宫平滑肌肉瘤,临床表现以阴道不规则流血为最主要的症状,病理分期以I期多见。

Objective To analyze the clinical and pathological features of uterine sarcoma with different histological types.Methods Clinical and pathological features in 78 cases of uterine sarcoma were analyzed retrospectively with observation on the histomorphology and immunohistochemical method,and reviewing the related literature at the same time.Results（1）78 cases of uterine sarcoma consist of 35 carcinosarcoma（44.9%）,25 leiomyosarcoma（32.1%）,16 endometrial stromal sarcoma（20.5%）,and 2 adenosarcoma（2.6%）.（2）35 Mullerian mixed tumor aged from 16 to 75 years,and average age was 57.3 years old.27 tumors located in uterine lumen（77.1%）.32 tumors were of the homologous（91.4%） type and 3 of the heterologous type（8.6%）.Among 35 cases,21 cases were stage I（60%）.（3） 25 leiomyosarcoma aged from 31 to 61 years and average age was 46.2 years old.9 tumors located in uterine lumen（36%）.7 tumors located in uterine muscle wall（28%）.Among 35 cases,17 cases were stage I（68%）.（4） 16 cases of endometrial stromal sarcoma,aged from 25 to 59 years,average age was 48.9 years old.12 cases were low grade endometrial stromal sarcoma,aged from 28 to 56 years,average age was 42.3 years old.4 cases were undifferentiated endometrial sarcoma,aged from 52 to 58years;average age was 54.7 years old.Among 16 cases,6 tumors located in uterine lumen with invading uterine muscle wall（37.5%）,11 cases were stage I（68.8%）,（5）2 adenosarcoma,1 patient was 40 years old,and the tumor located in uterine lumen,stage I.Another patient was 35 years old,which tumor located in the cervix of the uterus,stage II.Conclusion Among 78 cases of uterine sarcoma,carcinosarcoma is the most common uterine sarcoma,and their years old are relatively older;leiomyosarcoma is in the second place of uterine sarcoma.The clinical symptom in most patients of uterine sarcoma present abnormal vaginal bleeding,and also most of them are in stage I.