子宫Müllerian腺肉瘤5例临床病理分析

Müllerian adenosarcoma of the uterus:A clinicopathology analysis of 5cases with literature review

目的探讨子宫Müllerian腺肉瘤(Müllerian adenosarcoma)的临床与病理学特点及鉴别诊断。方法观察分析5例子宫腺肉瘤的临床病理资料和免疫表型,并复习相关文献。结果大体上5例均表现为子宫腔内的息肉样肿块,组织学上有特征性的分叶状结构、腺体周围"袖套样"结构及裂隙状腺体,部分间质呈息肉样突入腺腔;1例伴性索样分化,1例伴肉瘤成分过度生长及骨样分化。免疫组化显示间质细胞不同程度表达CD10,尤其是腺体周围的细胞。结论子宫Müllerian腺肉瘤是一种少见的子宫肉瘤,需与一系列良恶性病变鉴别,常需多次刮宫甚至术后病理检查才能确诊,熟悉其病理学特征有助于诊断及鉴别诊断,免疫组织化学的作用有限。

Objective To investigate the clinicopathological features as well as the differential diagnosis in Mullerian adenosarcoma of the uterus. Methods Clinical and pathological data, feature with immunohistochemical markers were analyzed and studied in five cases of uterine Mullerian adenosarcoma. The relevant literature was also reviewed. Results All uterine tumors were polypoid or nodular masses, usually protruding into the endometrial cavity. Characteristic histologic features included phyllodes-like architecture and periglandular cuffs of increased cellularity. Usally crack-like glands and intraglandular protrusions of cellular stroma were seen. One case showed sex cordlike differentiation, another case showed sarcomatous overgrowth and osteoid differentiation. Immunohistochemical staining for CD10 was positive in all cases, especially the periglandular cells. Conclusions Uterine Mullerian adenosarcoma has been diagnosed by multiple curettage or even postoperative pathologic results frequently. It＇s histological features can help with the diagnosis as well as differential diagnosis. The role of immunohistochemistry is limited.