息肉样子宫内膜异位症10例临床病理分析

Clinicopathological study of ten cases with polypoid endometriosis

目的：探讨息肉样子宫内膜异位症的病理组织学特征。方法对10例息肉样子宫内膜异位症进行回顾性分析，观察其临床病史、大体及镜下特征以及免疫表型特征。结果10例患者年龄27-54岁，平均39．4岁，临床症状均表现为盆腔包块，在卵巢、子宫浆膜面及子宫颈管均表现为外生性或息肉样生长，同时并存相应部位的子宫内膜异位症或内膜样囊肿；镜下见病变由良性子宫内膜样腺体和子宫内膜样间质组成，内膜腺体常呈单纯性增生过长，伴输卵管黏膜纤毛细胞化生，间质可发生纤维化，伴不典型间质细胞。随访的9例患者均存活，未见病变复发。结论息肉样子宫内膜异位症在子宫内膜异位症基础上出现局部异位内膜的过度生长，是一种少见的子宫内膜异位症的特殊表现形式，易误诊为腺肉瘤。认识该类病变的最重要意义在于避免术中、术后病理检查中误判为恶性肿瘤或其他良性肿瘤性病变，影响其临床处理和治疗。

Purpose Polypoid endometriosis is an uncommon and distinctive variant of endometriosis, and its detailed histopathological features have been investigated and analysed. Methods A retrospective analysis was performed in 10 cases with polypoid endometrio-sis by comparing clinical data, histopathologic and immunohistochemical changes. Results The patients were 27 to 54 years （ mean 39. 4 years） of age. The most common clinical presentations were a pelvic mass. The intraoperative findings suggested a neoplasm. Sites of involvement in order of frequency included ovary, uterine serosa and cervix. Polypoid, pink, gray or tan masses ranged up to 9 cm in maximal dimension. On microscopic examination, the polypoid masses were composed of an admixture of endometriotic glands and stroma. Most commonly glandular architectural patterns were simple hyperplasia. Tubal epithelial metaplasia was common. The stroma was fibrous, resembling to some extent the stroma of the endometrial polyp and atypical stromal cells can be seen. Nine cases were associated with usual endometriosis. Follow-up data in nine patients indicated that all of patients were alive without evidence of re-sidual disease. The main lesion in the differential diagnosis is a mullerian adenosarcoma. Conclusion Polypoid endometriosis is a rare manifestation of endometriosis, and probably is overgrowth of local ectopic endometrium based on endometriosis. Understanding of such lesions is avoided misdiagnosing for other benign or malignant tumors on clincal, intraoperative or pathologic assesment, and influ-ences the clinical treatment.