宫颈Müllerian腺肉瘤临床病理观察

Mullerian adenosarcomas of uterine cervix: a clinicopathologic study

目的探讨子宫颈Müllerian腺肉瘤(MAs)的临床病理特征、免疫表型、鉴别诊断及治疗。方法对1例宫颈MAs行光镜、免疫组化检查,复习临床资料及相关文献。结果本例瘤组织上皮成分为宫颈管腺体,腺体成裂隙状,间质细胞分布不均,在腺体周围呈袖套样分布,伴轻~中度细胞异型性,核分裂象>7个/10HPF。免疫组化间质细胞ER和PR(+),SMA、desmin和CD10部分(+),h-Caldesmon(-)。结论宫颈MAs较罕见,诊断主要依靠组织形态特征,免疫组化有助于鉴别诊断和确定异源性成分,组织中有无间质过度生长和肌层浸润影响患者预后,也是临床术式选择和是否辅助治疗的主要依据。

Objective To investigate the clinicopathologic features,immunophenotype,differential diagnosis and clinical treatment of Müllerian adenosarcomas（ MAs） of the uterine cervix. Methods This case of primary MAs in the uterine cervix were microscopically observed and immunohistochemical staining was performed for the tumor tissue blocks. The clinical data and relevant literatures were reviewed. Results The glands of our case were cervical glands that were surrounded tightly by malignant stroma with mild to moderate atypia,forming the＂peri-glandular cuffing＂. Mitotic activity of the stromal component was higher（ 7/10 HPF）,pronounced in areas of periglandular cuffing. Immunohistochemical staining of sarcomatoid cells showed positive for SMA,desmin,CD10（ part）,ER and PR,but negative for h-caldesmon;Ki-67 was positive（ 5%）. Conclusions Primary MAs of uterine cervix is rare,and the diagnosis depends on the morphologic features. The prognosis is influenced by the sarcomatous overgrowth and myometrial invasion,which also affect the extent of operation and the choice of adjunctive therapy.