子宫内膜样癌伴MELF浸润的临床病理特点及预后分析

Microcystic, elongated and fragmented invasion pattern in endometrial carcinoma: the clinicopathology analysis

目的探讨子宫内膜样癌伴微囊、拉长及碎片状(MELF)浸润患者的临床病理特点及预后。方法收集2015年4月—2016年10月于北京大学人民医院行子宫全切除+双侧附件切除+盆腔(或加腹主动脉旁)淋巴清扫术的108例子宫内膜样癌患者的临床病理资料,筛选出其中伴MELF浸润的子宫内膜样癌患者25例,回顾性分析其临床病理资料,总结其免疫组化染色的特点,并对其预后进行随访。MELF浸润是指低级别子宫内膜样癌的肌层中以微囊型腺体、拉长变形的腺体以及碎片状腺体形式出现的1种特殊的浸润方式。结果子宫内膜样癌伴MELF浸润的发生率为23.1%(25/108),患者年龄为(59.3±10.9)岁(46~76岁);绝经前4例、绝经后21例;临床表现以阴道不规则流血为主;MELF浸润灶通常位于紧邻肿瘤主体的周围组织或深肌层中。25例伴MELF浸润的子宫内膜样癌患者的淋巴脉管间隙浸润(LVSI)阳性率(52%,13/25)和淋巴结转移阳性率(20%,5/25)均明显高于不伴MELF浸润的子宫内膜样癌患者[均为2%(2/83),P<0.01]。免疫组化法检测显示,MELF浸润组织中,ER、PR、细胞增殖相关核抗原(Ki-67)、β半乳糖凝集素3(galectin-3)呈弱阳性表达,上皮型钙黏蛋白(E-cadherin)呈中等强度阳性表达,细胞角蛋白(CK)呈弥漫性强阳性表达。25例伴MELF浸润的子宫内膜样癌患者术后随访(23.2±5.9)个月(14~33个月),均未出现复发及转移。结论MELF浸润是发生于低级别子宫内膜样癌的特殊浸润方式,伴MELF浸润的子宫内膜样癌患者LVSI阳性率及淋巴结转移阳性率明显增高,提示其预后较差。

Objective To assess the clinical value for the clinicopathological features of microcystic elongated and fragmented (MELF) invasion in endometrial carcinoma (EEC). Methods The clinicopathological data of 108 cases of endometrial carcinoma with total hysterectomy, bilateral adnexectomy, and pelvic dissection were retrospectively analysis in Peking University People′s Hospital from April 2015 to October 2016. Twenty-five patients with endometrial carcinoma showing MELF invasion pattern were collected. We analyzed retrospectively the association of MELF pattern invasion with clinical pathology data and prognosis of the patients, partial immunohistochemical staining was implemented. MELF invasion was a special invasion pattern and characterized by microcystic, elongated, fragmented (composed of cluster cells) gland in muscular layer. Results The incidence rate was 23.1% (25/108). These patients mean age was (59.3±10.9) years old. Four cases were premenopausal, and 21 were postmenopausal. Abnormal vaginal bleeding was the main clinical presentation. The lesions tend to appear adjacent to the tumor body. Sometimes, it may be appears away from the tumor body in the deep muscle layer.Lymph node metastasis were present in 5 cases (20%, 5/25). Thirteen cases (52%, 13/25) of them demonstrated lymph vascular space involvement (LVSI). The immunohischemical expression of ER,PR, Ki-67 and galectin-3 showing MELF invasion pattern were weaker than no showing MELF invasion pattern endometrial carcinoma, cktokeratin (CK) was showed diffuse strong positive expression, E-cadherin was moderately positive expression. All 25 cases were followed up for (23.2±5.9) months (14-33 months) after the therapy with no recurrence on metastasis. Conclusions MELF invasion pattern is a special invasion pattern in low-grade EEC. The incidence of LVSI and lymph node metastasis rate in endometrial carcinoma with MELF invasion are significantly increased. The prognosis of MELF invasion pattern may be poor.