22例子宫卒中性平滑肌瘤的临床病理特征分析

Analysis of the Clinicopathologic Characteristics of 22 cases of Uterine Apoplectic Leiomyomas

目的:探讨卒中性平滑肌瘤的临床病理特征、免疫表型及预后。方法:回顾性分析22例子宫卒中性平滑肌瘤的临床特点、病理形态学特点及免疫表型,并复习相关文献。结果:卒中性平滑肌瘤患者的临床症状主要为异常子宫出血,腹痛等。肿瘤大体常伴有以下特征,多灶性出血、坏死、囊性变、水肿变性及质地变软等,镜检可见多灶出血区,呈放射状、卵圆形或不规则形,其中央常可伴有坏死、玻璃样变或肿瘤细胞减少,周边肿瘤细胞富集。22例卒中性平滑肌瘤中,15例核分裂增加(最高达13个/10HPF),但细胞均未见病理性核分裂及显著细胞异型性;22例肿瘤组织弥漫强表达Desmin、SMA、H-caldesmon,Ki67指数范围(3%-15%);18例出血及凝固性坏死区及其周围的肿瘤组织不同程度表达CD10。22例患者均获得完整随访资料,平均随访30个月(10~110个月),均无瘤生存。结论:子宫卒中性平滑肌瘤预后较好,但由于其具有一系列异常的病理形态学特征,如多发出血灶,出血灶中央可伴有坏死,其周围富于肿瘤细胞区细胞可见轻度非典型性且核分裂不同程度增加,易被误诊为子宫恶性潜能未定的平滑肌瘤甚至是子宫平滑肌肉瘤。正确认识该类肿瘤宽广的形态学谱系,有助于临床病理医师做出正确诊断。

Objective： To investigate the clinicopathologic characteristics, immunophenotype and prognosis of uterine apoplectic leiomyomas. Methods： 22 cases diagnosed as uterine apoplectic leiomyomas were retrospectively analyzed for clinicopathologic findings, pathology and immunophenotypes, followed with review of the literatures. Results： Clinical aspects including abnormal uterine bleeding, pelvic pain, and so On. Macroscopically, the tumor had multiple gross hemorrages, necrosis, cyst formation, edema, softening, and so on. On mircroscopic evaluation, apoplectic changes of the tumors are multifocal and stellate, ovoid or irregularity. Necrosis, hyalinization, and hypercellularity were common. The mitotic index of 15 cases had increased （maximum 13/10HPF）, without pathological mitotic or markedly atypia. Immnuohisochemical study showed that all cases were positive for Desmin, SMA, H-caldesmon, and Ki67 index is 3% -15%, and 18 cases were focal positive for CD10 in the areas of hemorrages, necrosis, and tumor cells around which. Follow-up informa- tion of all cases were obtained, mean 30 months （10-110 months）, all patients were disease free surviving. Conclusion： The prognosis of uterine apoplectic leiomyomas is well, but as the unusual histomorphology features of which, such as multifocal hemorrages, necrosis, moderate cells atypia and high mitotic index, difficulty often arose in determining whether the tumors were benign, malignant, or of uncertain malignant potential. Recognition of their wide morphologic spectrum will enable correct diagnosis.