息肉样子宫内膜异位症3例临床病理观察

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、诊断与鉴别诊断。方法应用光镜观察及免疫组化染色对3例少见的息肉样子宫内膜异位症进行临床病理学分析。结果 2例患者年龄均为48岁,1例为41岁。3例均表现为宫旁肿物,其中例1与子宫右后壁相连,呈结节状;例2、3均有子宫内膜异位症病史且多次复发。例2起初为双侧卵巢及盆腔肿物,现为子宫浆膜面多囊性肿物;例3初始为子宫下段浆膜面肿物,现为盆腔、阴道断端及髂窝肿物。镜下3例病灶中均可见子宫内膜样腺体及间质成分,其中例1形态学类似子宫内膜息肉,呈单纯性或复杂性增生,部分腺体伴非典型增生,局灶间质细胞有异型性;例2、3部分区域腺腔被覆宫颈型或肠型黏液上皮,部分腺体增生较活跃,呈交界性表现。例1和3术后未治疗,例2术后化疗2周期。目前3例分别随访7、3、28个月,一般状况良好。结论息肉样子宫内膜异位症少见,常发生于绝经后女性,其临床和病理表现均不同于普通型子宫内膜异位症,易被误诊为恶性肿瘤。性激素可能在其发病机制中起作用,预后良好。

Objective To study the clinical and histopathologic features, diagnosis and differential diagnosis of polypoid endometriosis. Methods Three rare cases of polypoid endometriosis were studied by microscopy, immnnohistochemistry, with review of related literature. Results Two cases were 48 year-old women, and the other one was 41 years old. Case 1 presented with a nodular mass protruding from the right rear of her uterine serosa. The other two cases presented with recurrent masses with ill-defined borders in the uterine, involving the omentum and pelvic, mimicking a malignant tumor. Microscopically, all of the cases were composed of endometriotic glands and stroma. Case 1 simulated to endometriotic polyp, with simple or complex hyperplasia, and some atypical glands and loci of marked atypical stroma. Cases 2 and 3 demonstrated that most glands were lined by endocervical or intestinal epithelia, some glands were dilated and filled with mucous, mucous lake came into being in the stroma, with myometrial invasion, and usual endometriosis could be seen in some areas. The similar lesion also involed the omentum in Case 2. Cases 1 and 3 were untreated postoperatively, and Case 2 underwent 2 courses of chemotherapy. Three cases were alive after 7, 3 and 28 months of follow-up. Conclusions Polypoid endometriosis is a rare manifestation of endometriosis that may be mistaken for a neoplasm on clinical, intraoperative, or pathologic assessment, and it most commonly ocurs in postmenopausa] women. Some cases may evolve into a borderline tumor, whose prognosis is good. Hormonal factors may play a role in its pathogenesis.