子宫非典型息肉样腺肌瘤临床及病理学特点

Clinical and Pathological Features of Atypical Polypoid Adenomyoma

目的探讨子宫非典型息肉样腺肌瘤(APA)临床病理学特点及鉴别诊断。方法收集无锡市妇幼保健院2010年1月—2016年12月诊断的子宫非典型息肉样腺肌瘤4例,分析其临床表现,病理形态学特点及免疫组化结果 ,并进行文献复习。结果 4例患者年龄33~60岁,中位年龄38岁,临床表现为不规则阴道流血或月经量增多。组织学特点为腺体不同程度增生,腺上皮伴异型,4例均伴鳞状上皮化生,腺体周围为增生的纤维肌瘤样间质细胞。2例行息肉切除或诊刮术,1例行全子宫切除术,1例全子宫双附件切除。3例术后随访6~33个月,均无瘤健在,1例失随访。结论 APA临床少见,病理形态学需与高分化子宫内膜样腺癌鉴别,总体临床预后良好,少数可合并或发展为子宫内膜腺癌,临床应根据年龄及有无生育要求制定治疗方案,均应密切随访。

Objective To study the clinical pathologicla features and differential diagnosis of atypical polypoid adenomyoma. Methods 4 cases of patients with atypical polypoid adenomyoma diagnosed in our hospital from January 2010 to December 2016 were selected and the clinical manifestations, patholgoical morphological characters and immunohistochemical results were analyzed and the literatures were reviewed. Results Of 4 cases of patients, the age was 33-60 years old and the median age was 38 years old, and the clinial manifestations were the irregular vaginal bleeding or increased menstrual blood volume, the histological characteristics were different degress of gland hyperplasia and glandular epithelium with atypia, 4 cases were with squamous metaplasia and the hyperplastic inomyoma-like mesenchymal cells, 2 cases were with polypectomy or curettage, 1 case was with panhysterectomy, 1 case was with total hysterectomy and bilateral appendectomy,and 3 cases were followed up for 6 months to 33 months, no tumors and 1 case was lost to follow-up. Conclusion The APA in clinic is rare, and pathomorphology needs to be identified from well-differentiated endometrioid adenocarcinoma, and the total clinical prognosis is good, and some can be combined with or developed to the adenocarcinoma of endometrium, and we need to make the treatment plan accoridng to the age and whether they have reproductive requirements or not, and the close follow-up should be conducted.