混合性子宫内膜间质和平滑肌肿瘤2例临床病理分析

Clinicopathological Analysis of Mixed Endometrial Stromal and Smooth Muscle Tumors:A Report of Two Cases

目的探讨混合性子宫内膜间质和平滑肌肿瘤(MESSMT)的临床病理特征及诊断和鉴别诊断。方法对2例MESSMT患者进行苏木精-伊红和免疫组化SP法染色光镜观察,结合临床资料进行分析并复习相关文献。结果肉眼观:2例均为子宫全切标本,肿物呈结节状,位于肌壁间,与肌壁分界尚清,1例伴有显著的黏液变及囊性变;光镜:肿瘤由梭形和圆形两种细胞构成,弥漫密集或不规则束状排列,两种成分均超过30%。肿瘤间质有明显的玻璃样变,形成网格状和类似花环或"星爆样"结构。肿瘤与子宫肌壁大部分分界清楚,局部舌状浸润。免疫组化:内膜间质成分细胞表达vimentin、CD10阳性,平滑肌成分表达vimentin、SMA、Desmin、h-caldesmon阳性。结论 MESSMT是一种非常罕见的子宫间叶性肿瘤类型,应与富于细胞性平滑肌瘤等肿瘤鉴别,免疫组化具有重要辅助作用。

Objective To investigate the clinicopathological characteristics,diagnosis and differential diagnosis of mixed endometrial stromal and smooth muscle tumors（MESSMT）. Methods Two cases of MESSMT were studied by histopathological observation and immunohistochemical staining. Results The two samples were collected from the cases underwent total hysterectomy. The tumors were located in the myometrium and had a approximate clear boundary,with nodular appearance. One case had significant mucus and cystic degeneration. The tumors were composed of spindle-shaped and round cells observed with microscope,diffuse dense or irregular bundles arranged,both components were more than30%. Tumor interstitial showed obvious hyalinization,with the grid-like and rosettes or so-called ＂star burst＂structure. A good demarcation was observed between tumor and myometrium,with tumor infiltrating myometrium in some regions.Immunohistochemistry showed that the endometrial stromal components were positive for vimentin and CD10,the smooth muscle components were positive for vimentin,SMA,Desmin and h-caldesmon. Conclusion MESSMT is rare.It should be distinguished from other smooth muscle tumors. Immunohistochemistry plays an important role in differential diagnosis.