国际妇产科联盟Ⅰ期子宫Mallerian腺肉瘤的预后相关临床病理学特征

Prognosis-related clinicopathologic characteristics of FIGO stage Ⅰ Miillerian adenosarcoma of uterus

目的探讨国际妇产科联盟（FIGO）宋欣期子宫Mtillerian腺肉瘤患者的预后相关临床病理特征。方法收集2005至2017年就诊于解放军总医院的子宫Mtillerian腺肉瘤15例患者临床资料、形态学及免疫组织化学表型，其中12例随访资料完整，根据预后情况分为A（无瘤生存7例）、B（死亡或肿瘤进展5例）两组，比较其临床病理特征并复习相关文献。结果A组与B组的患者中位年龄（43岁：56岁）和肿瘤直径（4．3cm：7．3cm）比较有一定的差异。A组病例分期均不超过FIGOIB期，肉瘤成分以低级别为主（5／7），少见出血坏死（1／7），少数病例伴肉瘤成分过度生长（SO）。B组则无FIGOIA期病例，多见高级别肉瘤成分（3／5）、出血坏死（3／5）及SO（4／5）。A组肉瘤细胞大多数表达雌激素受体（ER）、孕激素受体（PR）和CD10（均为6／7），Ki-67阳性指数大多≤20％（5／7）；B组则多数不表达ER、PR（均3／5），CD10虽多数表达但范围明显减少，Ki-67阳性指数大多≥30％（4／5）。结论Miillerian腺肉瘤大多呈低度恶性临床经过，预后不良与分期较晚可能相关。对于FIGO宋欣期患者，不良预后可能与SO，高级别肉瘤形态，深肌层浸润，CDIO、ER和PR表达降低或缺失，Ki-67阳性指数增高（≥30％）及出血坏死有关。在子宫内膜异位症基础上多中心发生者应视具体情况进行分期。

Objective To investigate the clinicopathological features of FIGO stage Ⅰ uterine Mtillerian adenosareoma and clinical prognosis. Methods Fifteen cases of uterine Miillerian adenosarcoma at FIGO stage Ⅰ were collected at PLA General Hospital from 2005 to 2017. Twelve cases with complete follow-up data were divided into 2 groups： group A （7 patients with survival） and group B （5 patients of death or tumor progression）. Clinicopathologic features were compared between the two groups. Results The median age of the patients was 43 years and 56 years, and the tumor size was 4. 3 cm and 7.3 cm for group A and B, respectively. Cases in group A were FIGO I A and I B stage tumors and were mainly low grade in histology （5/7） with rare tumor hemorrhagec, necrosis （1/7） and sarcomatous overgrowth. In contrast, most cases in group B were high grade sarcomas （3/5） with frequent hemorrhage, necrosis （3/5） and sarcomatous overgrowth（4/5）. Most cases of group A expressed ER, PR and CD10 （6/7） and low Ki-67 index of ≤ 20% （5/7）. While most group B cases lost expression of ER and PR （3/5）, significantly reduced expression of CD10 and higher Ki-67 index of ≥ 30% （4/5）. Conclusions Most of uterine adenosarcomas are of low malignant potential. The main prognostic indicator is advanced tumor stage. For patients at stage Ⅰ , sarcomatous overgrowth, high-grade histology, deep myometrial invasion, decreased or absent expression of CD10, ER and PR, increased Ki-67 index（ ≥ 30%） and hemorrhagic necrosis may indicate poor prognosis. Mullerian adenosarcomas arising from endomeriosis may present unusual growth patterns.