息肉样子宫内膜异位症临床病理分析

Polypoid endometriosis: a clinicopathological analysis

目的探讨息肉样子宫内膜异位症的临床病理学特征、鉴别诊断及发病机制。方法收集6例息肉样子宫内膜异位症的临床及病理资料,采用HE及免疫组化染色,分析其组织形态学及免疫表型,并复习相关文献。结果患者主因阴道出血、卵巢肿块就诊,平均年龄41.3岁。病变主要位于卵巢子宫内膜囊肿内、阴道后穹窿、直肠前壁及左侧阔韧带后叶。眼观:均为类圆形息肉样肿块,切面灰白、灰红色,质软,4例病变单发,2例多发。镜检:病变由子宫内膜样腺体及类似子宫内膜间质细胞的短梭形细胞构成,伴成簇的厚壁血管。腺上皮及间质细胞均无非典型性,核分裂象少见。免疫表型:腺上皮细胞ER、PR、CKpan阳性;间质细胞ER、PR、vimentin、CD10阳性,腺上皮细胞及间质细胞Ki-67增殖指数<5%。截止随访日期均未见患者复发。结论息肉样子宫内膜异位症是子宫内膜异位症的一种罕见亚型,具有独特的临床病理及分子遗传学特征,在临床及病理诊断中易误诊为恶性肿瘤,需与Müllerian腺肉瘤、卵巢宫内膜样腺癌、苗勒管乳头状瘤和纤维上皮性息肉等相鉴别。

Purpose To study the clinicopathological features and differential diagnosis and mechanism of the polypoid endometriosis. Methods The samples of 6 cases with polypoid endometriosis were studied by means of clinical and follow-up data, light microscopy and immunohistoehemistry, and the related literatures were reviewed. Results The patients were average 41.3. Sites of involvement included ovary, vaginal mucosa, rectum and broad ligament. Grossly, the lesions formed polypoid masses and the cut surfaces were pink, gray and tan. 4 of the cases were single mass, the other 2 were multiple. Microscopically, pathological characteristics of the pol- ypoid endometriosis appeared resemble to that of endometrial polyp of uterus, the polypoid masses were composed of an admixture of endometrial type glands and stroma. There was no architectural complexity or cytological atypia of glands or stroma. Immunohistoehemi- eally, all glandular epithelium showed positivity for oestrogen receptor （ER） , progesterone receptor （PR） and CKpan, stromal cells were positive for CD10, vimentin, ER and PR. The Ki-67 index were less than 5%. Conclusions Polypoid endometriosis is a rare manifestation of endometriosis that may be mistaken for a neoplasm on clinical or pathologic assessment. The differential diagnosis in- clude Mtillerian adenosarcoma, ovarian endometrial carcinoma, Mtillerian papilloma and fibroepithelial polyp.