子宫上皮样平滑肌瘤的临床病理及生物学特征分析

Analysis of the Clinical Pathologic and Biological Characteristics of Uterine Epithelioid Leiomyoma

目的分析子宫上皮样平滑肌瘤的临床病理和生物学特点,以提高临床鉴别诊断的准确率。方法选取2013年8月至2016年10月在洛阳市第一人民医院及河南科技大学第一附属医院接受治疗的60例子宫上皮样平滑肌瘤患者作为研究组,并选择同期接受治疗的30例低度恶性子宫内膜间质肉瘤患者作为对照组。观察并比较两组患者的临床和病理组织学以及免疫组织化学特点。结果研究组患者无特征性临床表现,镜下观察结果显示肿瘤细胞多呈现多边形、卵圆形或圆形,细胞核呈现卵圆形或圆形,细胞质部分伴有明显的空泡化变化,类似核周晕,或嗜伊红染色,部分细胞胞浆透明,为富含糖原的透明细胞。核分裂象平均0~1个/10HPF。免疫组织化学:60例患者Des和actin均阳性表达,38例EMA阳性表达,9例CD10呈弱阳性表达。对照组患者中10例actin阳性表达,7例Des阳性表达,4例EMA阳性表达,14例CD10阳性表达,两组患者免疫表型比较均具有明显差异(P<0.05)。结论子宫上皮样平滑肌瘤是临床较为少见的一种特殊类型的子宫平滑肌瘤,缺乏典型的临床表现,但具有特殊的病理学和生物学特征,对于鉴别诊断和治疗具有重要价值。

Objective To analyze the clinical pathologic and biological characteristics of uterine epithelioid leiomyoma so as to improve the accuracy of clinical differential diagnosis. Methods A total of 60 cases of patients with uterine epithelioid leiomyoma treated in The First People＇s Hospital of Luoyang and The First Affiliated Hospital of Henan University of Science and Technology from August 2013 to October 2016 were selected as the study group, and 30 cases of patients with low -grade endometrial stromal sarcoma treated in the same period were selected as the control group. The clinical,histopathological and immunohistochemical characteristics of the two groups were observed and compared. Results Patients in study group had no distinctive clinical manifestations, the microscopic observation results showed that the tumor ceils were mostly polygonal, oval or round, the cell nucleus were oval or round, the cytoplasm presented obvious change of vacuolization, which was similar to perinuclear halos or eosinophilic staining, part of the cytoplasm was transparent, suggesting the abundance of glycogens. The mitotic figure had an average of 0 - 1/10HPF. The immunohistochemical results showed that 60 cases of patients had positive expression of Des and actins, 38 cases had positive expression of EMA, and 9 cases had weakly positive expression of CD10. In control group, 10 cases of patients had positive expression of actins ,7 cases had positive expression of Des,4 cases had positive expression of EMA, 14 cases had positive expression of CD10, and a significant difference was found in immunophenotyping between the two groups （ P 〈 0.05 ）. Conclusion Uterine epithelioid leiomyoma is a particular type of uterine leiomyoma rarely seen clinically, it lacks typical clinical manifestations, but has special pathological and biological characteristics, which is of important value for differential diagnosis and treatment.