子宫内膜息肉样腺肌瘤8例临床病理分析

Endometrial polypoid adenomyoma: clinical and pathological analyses

目的探讨子宫内膜息肉样腺肌瘤的临床病理特征、诊断及鉴别诊断。方法对8例子宫内膜息肉样腺肌瘤进行临床病理资料分析、光镜观察及免疫组化染色。结果本组8例患者的发病年龄为38～53岁,中位年龄43.5岁。主要临床表现为阴道不规则出血。B超及宫腔镜示疑为子宫黏膜下平滑肌瘤和子宫内膜息肉。组织学主要表现为,增生性子宫内膜样腺体不规则散布于富含平滑肌的纤维性间质中;其中1例腺体结构复杂,腺上皮细胞轻～中度非典型性,为非典型性息肉样腺肌瘤(APA);7例为息肉样腺肌瘤。免疫组化:间质细胞SMA和desmin弥漫(+)。结论子宫内膜息肉样腺肌瘤是一种上皮和间叶组织混合的良性肿瘤,非典型性息肉样腺肌瘤具有复发倾向及恶变潜能,在活检标本中需与子宫内膜癌侵及肌层相鉴别。

Objective To study the clinicopathologic features,diagnosis and differential diagnosis of endometrial polypoid adenomyoma.Methods The clinicopathologic features of eight cases of the endometrial polypoid adenomyoma were analysed with light microscopy and immunohistochemical staining.Results The age of the eight cases ranged from 38 to 58 years,with the mean of 48 years.The main clinical symptom was abnormally vaginal bleeding.The eight cases were suspected to endometrial polyps and submucous myoma by B transonogram and hysteroscopy.Histologically,irregularly proliferated endometrial gland cells and interlacing bundles of smooth muscle cells presented within the stroma.Among the total,one case presented endometrial glands with complex and cellular atypia,which was atypical polypoid adenomyoma,and seven were polypoid adenomyoma.Immunohistochemically,the mesenchymal cells were diffusely positive for SMA and desmin.Conclusions Endometrial polypoid adenomyoma is a benign tumor of mixed epithelium and stroma.Atypical polypoid adenomyoma may recur with malignant potential.More attention should be paid to differentiate it from endometrial adenocarcinoma with invasion into muscle layers.