677例子宫平滑肌肿瘤的病理诊断

Pathological diagnosis of smooth-muscle tumors of the uterus:a report of 677 cases

目的 :探讨子宫平滑肌肿瘤的病理诊断。方法 :对 6 77例子宫平滑肌肿瘤重新观察肿瘤细胞密度、异型性、核分裂象、瘤细胞凝固性坏死和浸润性边缘 ,作出诊断。结果 :普通平滑肌瘤 6 5 4例 ,特殊组织类型平滑肌瘤 2 1例 (富于细胞型 7例 ,畸异型 4例 ,不典型性 9例 ,核分裂活跃型 1例 ) ,恶性潜能未定型平滑肌肿瘤 1例 ,平滑肌肉瘤 1例。普通子宫平滑肌瘤核分裂与月经周期显著相关。 4例特殊组织类型平滑肌瘤可见肿瘤血管内生长。随访表明特殊组织类型平滑肌瘤为良性经过。结论 :特殊组织类型子宫平滑肌瘤虽因形态有异 ,而易致误诊 。

Purpose To study the pathological diagnosis of smooth muscle tumors of the uterus. Methods Six hundred and seventy seven cases of smooth muscle tumors of the uterus were studied. Sections of the neoplasms were reexamined for cellularity,atypia,mitosis index,coagulation necrosis of tumor cells and marginal invasion. Results There were 654 cases of usual leiomyoma,21 special histological type of leiomyoma (including 7 cellular leiomyoma, 4 bizzare leiomyoma,9 atypical leiomyoma and 1 mitotically active leiomyoma),1 smooth muscle tumor of uncertain malignant potential and 1 leiomyosarcoma.Mitotic counting correlated with the phase of the menstrual cycle in usual leiomyomas.Vascular ingrowth by tumor was present in 4 cases of special histological type of leiomyoma. Follow up showed that uterine leiomyomas with special histological type had a benign course. Conclusions Uterine leiomyomas with special histological type should not be designated as borderline tumors. Uterine smooth muscle tumors of uncertain malignant potential are borderline tumors.