子宫内膜简单型及复杂型乳头状增生13例临床病理学分析

Papillary proliferation of the endometrium: a clinicopathologic analysis of thirteen cases

目的子宫内膜乳头状增生( PPE)是一类少见病变,对其进行临床病理学分析,以进一步认识此类病变。方法对 13 例 PPE 的资料进行回顾性分析,观察其临床病史、大体及镜下特征。结果 13 例患者发病年龄为 24 ~75 岁(平均年龄 56 岁),9 例患者为绝经后妇女,临床症状主要表现为阴道出血。大体,11 例为子宫内膜诊刮或子宫内膜息肉摘除术后标本,2 例为子宫全切标本。镜下,9 例为子宫内膜简单型乳头状增生,4 例为子宫内膜复杂型乳头状增生;13 例均伴有不同类型的化生性改变( 100%),其中 8 例伴黏液性化生( 61. 5%),2 例伴鳞状化生( 15. 4%),2 例伴嗜酸性化生( 15. 4%),1 例伴输卵管上皮化生( 7. 7%),1 例同时伴有黏液性化生及嗜酸性化生( 7. 7%)。病变均局限于子宫内膜表面或子宫内膜息肉中,9 例合并子宫内膜息肉,2 例合并子宫内膜复杂性增生,1 例合并子宫内膜复杂性不典型增生,1 例合并子宫浆液性癌;13 例患者均有随访资料,随访时间 1 ~ 48 个月(平均14. 5 个月),均无复发。结论 PPE 具有独特的组织学特征,通常发生于绝经期妇女,最常见的症状为阴道出血,病变常局限于子宫内膜表面或子宫内膜息肉中。目前国内还没有系统报道,生物学行为及预后尚不完全明确,有待进一步研究和探索。

Objective Papillary proliferation of the endometrium ( PPE) has been subdivided into simple papillary proliferation and complex papillary hyperplasia based upon the degree and the extent of architectural changes. The aim of this article was to elucidate the clinicopathological characteristics of PPE to avoid misdiagnosis. Methods The clinical and pathological data of 13 cases of PPE were collected and analyzed. Results The age of the 13 patients ranged from 24 to 75 years,with a mean age of 56 years. The most common symptom was postmenopausal bleeding. The histologic diagnosis of PPE was made in 11 biopsy /curettage samples and in 2 hysterectomy specimens. Histologically,a simple papillary pattern with involvement of only a few glands and little epithelial proliferation occurred in nine cases. A complex papillary pattern with more extensive involvement of endometrial glands,a greater degree of branching of the papillae,and cellular tufting occurred in four cases. One or more metaplastic epithelial changes occurred in most of cases,including endocervical type mucinous metaplasia in eight cases ( 61. 5%),focal squamous metaplasia in two cases ( 15. 4%),eosinophilic cell change in two case ( 15. 4%),and ciliated cell change in one case ( 7. 7%). The results of follow-up for 13 patients from 1 to 48 months ( mean 14. 5 months) revealed that all patients were alive without recurrence. Conclusions These papillary proliferations are a form of hyperplasia that is closely associated with endometrial epithelial metaplasia. Polypectomy and/or curettage may be effective in removing them because they often are localized lesions.