子宫内膜非典型性息肉样腺肌瘤12例临床病理分析

Atypical polypoid adenomyoma of endometrium:a clinicopathologic analysis of 12 cases

目的探讨子宫内膜非典型性息肉样腺肌瘤的临床病理特征。方法对12例子宫内膜非典型息肉样腺肌瘤的临床资料和病理特征进行回顾性分析。结果 12例患者年龄24～62岁,其中3例行子宫全切及双附件切除术,9例宫腔镜下行肿瘤单纯切除术。镜下肿瘤由增生紊乱的分支状子宫内膜腺体构成,有明显的结构复杂性和细胞非典型性,细胞非典型性从不明显到非常明显;间质主要由平滑肌构成。其中9例可见灶状鳞状上皮化生,2例周围腺体有灶状不典型增生。免疫组化示间质细胞SMA和desmin弥漫或局灶(+),周围腺体CD10(-),腺上皮ER和PR弥漫(+);p53(-);Ki-67阳性率为12%。随访10例,时间3个月至4年,均无复发;2例失访。结论子宫内膜非典型息肉样腺肌瘤具有特异的病理学特征,其临床为良性过程,但是存在低度恶性潜能,治疗为完整切除肿物且临床严密随诊。

Objective To explore the clinical pathologic characteristics of atypical polypoid adenomyoma.Methods The clinical data and pathological characteristics were retrospectively analyzed in 12 cases of atypical polypoid adenomyoma.Results The age of the patients ranged from 24-62 years.The hysteroovariectomy was performed in 3 cases,and simple removal of tumors was conducted under hysteroscope in 9 cases.Microscopically,the tumor was composed of branching glands of endometrium with complicated structure and obvious atypia,and leiomyomatous stroma.Focal squmaous metaplasia was found in 9 cases and atypical hyperplasia of the gland in 3 cases.Immunohistochemical staining showed that stroma cells were positive for SMA and desmin and glandular cells were positive for ER and PR but negative for CD10 and p53.The follow-up in 10 cases showed that the patients were alive without tumor recurrance for 3 months to 4 years.Conclusion Atypical polypoid adenomyoma presents specific pathological features,and its clinical course is benign,but exists low malignant potential.It should be completely removed and closely followed up.