子宫腺肉瘤伴肉瘤样过度生长的临床病理分析

Clinicopathologic study of adenosarcoma with sarcomatous overgrowth of the uterine

目的探讨子宫腺肉瘤伴肉瘤样过度生长的临床病理特征、免疫表型及鉴别诊断。方法分析4例子宫腺肉瘤伴肉瘤样过度生长的临床病理资料,行病理形态学观察及免疫组化En Vision法检测,并复习相关文献。结果 4例患者均发生于子宫内膜,临床表现为绝经后阴道出血,或经期延长;宫腔内见息肉样结节,有蒂或无蒂;或内膜粗糙,切面呈鱼肉状,与周围组织界限不清。镜下见肿瘤由良性腺体成分和恶性间叶成分构成,肉瘤成分占25%以上,4例肿瘤中2例含有异源性的横纹肌肉瘤成分。肉瘤成分:vimentin(+),CD10部分(+);伴异源性横纹肌肉瘤成分:desmin、Myo D1、Myogenin均(+)。3例患者术后随访5、10、19个月后死亡,1例随访3个月无瘤生存。结论腺肉瘤伴肉瘤样过度生长,预后相对较差。

Purpose To investigate the clinicopathologic characteristtics, immunophenotype and differential diagnosis of uterine adenosarcoma with sarcomatous overgrowth. Metheds The clinicopathological data of 4 cases of uterine adenosarcoma with sarcomatous overgrowth were collected, the histopathologic and immunohistochemical features were investigated, and the rele- vant literatures were also reviewed. Results All of tumors were arised from the endometrium with complains of postmenopausal vaginal bleeding or prolonged menstrual period. There is a polypoid nodular in the uterine cavity with a pediclc or no pedicel, or rough endometrium. On the cut surface, the tumor was fishlike without distinct from the surrounding tissue. Light microscopy show the tumors were composed of benign glands and malig- nant mesenchymal components, the sarcomatouscomponents accounted for over 25%. In 4 cases,2 cases had heterologous component of rhabdomyosarcoma. The component of sarcomatous were positive for vimentin and CD10. The heterologous component of rhabdomyosarcoma were positive for desmin, MyoD1, and Myogenin. 3 cases were died at in 5, 10, and 19 months after operation, 1 patient was disease free survival for 3 months. Conclusion Uterine adenosarcoma with sarcomatous overgrowth has a bad prognosis.