年轻未孕女性子宫Müllerian腺肉瘤5例临床病理分析

Clinical-Pathological Analysis of Uterine Müllerian Adenosarcoma in the Young Females

目的:探讨年轻未孕子宫Müllerian腺肉瘤患者的临床病理特征,提高对该病的认识。方法:分析5例年轻未孕子宫Müllerian腺肉瘤患者的临床表现及病理组织学特点。结果:5例患者均以经量增多伴阴道不规则流血为初诊主诉,子宫均增大,4例有息肉样物脱出宫颈。肿瘤由良性腺上皮成分和肉瘤性间质成分组成。免疫表型,肉瘤成分普遍Vimentin阳性,大部分CD10阳性,部分Desmin、SMA阳性。5例中术前诊断3例;4例经术后病理检查证实。治疗主要采用次广泛全子宫+单侧附件+盆腔淋巴结切除,术后预防性化疗。结论:年轻未孕子宫Müllerian腺肉瘤的基本形态由良性腺上皮和肉瘤性间质混合组成。对年轻未孕患者出现阴道不规则流血并伴有息肉样物脱出宫颈,且伴子宫增大时要警惕子宫Müllerian腺肉瘤。治疗以手术为主,可辅以化疗。

Objective：To evaluate he clinical and pathological features of young nonpregnant patients with uterine Mullerian adenosarcoma. Methods：Analysis of clinical manifestations and histopathological features of five young nonpregnant patients with uterus Mullerian adenosarcoma. Results： Chief complaint of the 5 pa- tients were all increased irregular vaginal bleeding and enlarged uterus,of which polypoid material prolapse cervix were observed in 4 cases. In immunohistochemical anaylsis,the sarcomatous component had a posi- tive reaction for vimentin, desmin, CD10 and SMA. The glands component showed a positive reaction for cy- tokeratin, reticular fiber surrounding single or several tumor cells can be showed by Ag staining. 3 cases were preoperatively diagnosed and 2 cases missed before surgery. 4 cases diagnosed by pathologic examination, without surgery,and after repeated curettage in the preoperative diagnosis. Surgical treatment included sub- extensive hysterectomy, unilateral attachment and pelvic lymph node dissection and postoperative chemother- apy. Conclusions：Uterine Mullerian adenosarcoma usually occurred in postmenopausal women,and the majorclinical manifestations included irregular vaginal bleeding,enlarged usterus and prolapse of polypoid masses outside thecervix. The basic components of the tumor were benign gonadal epithelial and sarcoma interstitium mixed composition. The treatment strategy is surgery combined with chemotherapy.