子宫腺瘤样瘤36例临床病理分析

Adenomatoid tumors of the uterus: a clinical pathological study of 36 cases

目的探讨子宫腺瘤样瘤(adenomatoid tumors,ATs)的发生、命名、临床病理特征和鉴别诊断。方法对36例子宫ATs患者的临床病理资料进行回顾性分析并文献复习。结果 36例子宫ATs占同期子宫肿瘤切除标本的1.61%,肿瘤多位于子宫近浆膜下的肌壁间(31/36),均呈结节状生长,单发34例(94.4%),多发2例(5.6%),直径1.0～6.5 cm,边界清或欠清,无包膜。其中伴发子宫其他病变13例(36.1%),单纯为子宫ATs 23例(63.9%)。临床表现和影像学检查均无特征性。大体上类似平滑肌肿瘤,切面大多灰白、灰黄,实性均质,质硬或较软,少数切面湿润,可见细小腔隙和小囊腔,内含半透明黏液。镜下肿瘤由增生的平滑肌和上皮样成分组成,上皮样成分增生形成许多大小不等、形态不一的腺样或腔隙样结构,呈片、巢状或单个散在分布于平滑肌束之间,上皮样细胞无明显异型性,无核分裂象,增生的平滑肌呈束状或编织状排列。免疫表型:肿瘤上皮样成分CKpan、Calretinin呈阳性,CD34呈阴性。结论子宫ATs是一种少见的良性肿瘤,起源于浆膜间皮,临床及病理检查均易误、漏诊,免疫组化检测CKpan及Calretinin有助于诊断。其平滑肌成分是否应看作肿瘤的实质成分,有待探讨。

Purpose To investigate the development, naming, pathological features and differential diagnosis of uterine adenomatoid tumors （ATs）. Methods The clinieopathological features of 36 uterine ATs cases were analyzed retrospectively and the relevant liter- ature were reviewed. Results Uterine ATs accounted for 1.61% in the contemporaneous uterine excision biopsy tumors, most of which located in muscle intramural near serous membrane with nodular appearance. 34 cases （ 94.4% ） were single and 2 cases （5.6%） were multiple. The border was clear or vague with no capsule, the diameter were about 1.0 to 6. 5 centimeters. 23 cases （63.9%） were existed alone while the other 13 cases （36. 1% ） were accompanied with other uterine lesions. The clinical manifesta- tions and radiological examination lacked distinct appearance. The cut surface presented a nodular pattern like smooth muscle tumor with grayish white or yellowish in color, partially cystic containing translucent mucus. Microscopically, the tumor is composed of smooth muscle cells and epithelioid cells. The epithelioid cells were flaked, nested or single scattered in smooth muscle and formed dif- ferent size adenoid or lacuna structure. Immunohistochemistry staining showed that epithelioid ceils were positive for CKpan and Cal- retinin and negative for CD34. Conclusion The ATs, a rare benign and mesothelial origin tumor, were often misdiagnosed. Immuno- histochemistry techniques （CKpan and Calretinin） are useful in establishing a correct diagnosis of ATs. Whether the smooth muscle component should be regarded as the essence of tumor composition needs further discussion.