138例子宫腺瘤样瘤临床病理及免疫组化特征分析

Analysis of clinicopathological and immunohistochemical characteristics of 138 cases with adenomatoid tumor of uterus

目的探讨子宫腺瘤样瘤的组织发生、临床病理、免疫组化特征及鉴别诊断,提高子宫腺瘤样瘤的诊断水平。方法回顾性分析我科2004年1月~12月138例经病理确诊的子宫腺瘤样瘤的临床、巨检及光镜检查资料及免疫组化特征。结果子宫腺瘤样瘤占同期子宫标本的1.85%（138/7460）,其中合并平滑肌瘤和/或腺肌症占69.6%（96/138）。巨检肿瘤多位于肌壁间或浆膜下,平均直径2.4 cm,界限较清,但无包膜,切面呈实性,灰红或灰白色,部分呈灰黄色,部分可见细小裂隙或微囊甚至囊腔形成。光镜下见肿瘤由大小不等、形态不一的裂隙样或脉管样结构组成,腔内可见蓝染的分泌物,内衬有扁平、立方状细胞,胞质红染,核圆形或卵圆形,无明显异型性及病理性核分裂像。免疫组化显示内衬肿瘤细胞呈pan-CK、Vimentin、D2-40、Calretinin阳性,CD34、CEA、CD31、PAX2/8、SMA阴性,Ki-67增殖指数≤10%。结论免疫组化提示子宫腺瘤样瘤为间皮起源性肿瘤,多数伴有平滑肌瘤和（或）腺肌症,临床病理表现和免疫组化特征有助于该病的诊断和鉴别诊断。

Objective To analyze the histogenesis,clinicopathological and immunohistochemical features and differential diagnosis of adenomatoid tumors（ ATs） of uterus in order to improve the level of diagnosis. Methods Data of clinical information, autopsy and pathological morphology and immunohistochemical features of 138 cases with ATs of uterus diagnosed by pathology from January 2004 to December 2014 in our department were retrospectively analyzed. Results The cases of ATs of uterus were 1.85% of all uterus samples in corresponding time （138/7460）, in which uterine 1 eiomyoma or adenomyoma were 69. 6% （96/138）. The tumor autopsy showed that the tumors were located in the uterine muscle walls or under serosa with average size about 2.4 cm. The border of the ATs was clear without capsule. Section of the tumors showed the solid with gray red or white and some with gray yellowish. Some tumors had the lumen of the small fissure or micro cyst or cyst formation. Microscopically analysis showed that the tumors were consisted with differ- ent sizes of and irregular lacuna or vascular structures. The small cysts contained aizen secretion lined with squamous or cuboidal epi- theliums. The cells had red stain of cytoplasm, round or ovoid nuclear without atypical and pathological nuclear fissions. The IHC results indicated positive of pan-CK, vimentin, D2-40, calretinin and negative of CD34, CEA, CD31, PAX2/8, and SMA. Ki-67 was less than 10%. Conclusion The IHC results suggest that ATs of uterus is mesothelial in origin, mostly accompanying with 1 eiomyoma or adenomyoma. Clinicopathological manifestations and immunohistochemical characteristics should be used as an important evidence for diagnosis and differential diagnosis.