子宫内膜去分化癌6例临床病理特点

Clinicopathological characteristics of 6 cases of dedifferentiated endometrial carcinoma

目的探讨子宫内膜去分化癌的临床特征、病理组织学及免疫表型特点,对其诊断及鉴别诊断,进行综合性分析,加深对该病的认识。方法回顾性分析6例2015年1月至2020年6月沈阳二四五医院和中国医科大学附属盛京医院病理科的子宫内膜去分化癌,观察其临床病理特点,并复习相关文献。结果6例子宫内膜去分化癌患者平均年龄(59.83±5.15)岁,镜下见两种肿瘤细胞形态,一种是低级别子宫内膜样腺癌成分,另一种是未分化的圆形、卵圆形类似肉瘤样形态的细胞。免疫组化染色显示,未分化区域Vimentin均(+)、ER、PR均(-),上皮性标记CK(pan)、EMA局灶弱(+),CD56及Syn局部(+),5例P53为野生型,1例为(-,无义突变);低级别子宫内膜样腺癌区域Vimentin均(+)、ER、PR均(+)、CK(+),4例微卫星不稳定:MLH1和MSH2(-)。结论子宫内膜去分化癌是一种罕见类型的子宫原发的恶性上皮性肿瘤,具有特殊的临床病理组织形态特点,加深对该病的认识,可以提高病理诊断准确性,并能指导临床治疗。

Objective To investigate the clinical characteristics,histopathology and immunophenotype characteristics of dedifferentiated endometrial carcinoma,to conduct a comprehensive analysis of its diagnosis and differential diagnosis,and to deepen the understanding of the disease.Methods Six cases of dedifferentiated endometrial carcinoma from the Department of Pathology in the 245 Hospital of Shenyang and Shengjing Hospital Affiliated to China Medical University from January 2015 to June 2020 were retrospectively analyzed.The clinicopathological characteristics were observed,and the relevant literature was reviewed.Results The average age of the six patients with dedifferentiated endometrial carcinoma was(59.83±5.15)years old.Two tumor cell morphologies were observed under the microscope,one of which was a low-grade endometrioid adenocarcinoma,and the other was an undifferentiated round and oval cells that resemble sarcoma-like morphology.Immunohistochemical staining showed that the undifferentiated areas were all vimentin(+),ER,PR all(-),epithelial markers CK(pan),EMA focally weak(+),CD56 and Syn local(+),and 5 cases of P53 were wild type,1 case was(-,nonsense mutation);low-grade endometrioid carcinoma areas were all vimentin(+),ER,PR(+),CK(+),4 cases of microsatellite instability,and MLH1 and MSH2 negative.Conclusion Endometrial dedifferentiated carcinoma is a rare type of primary malignant epithelial tumor of the uterus.It has special clinicopathological histomorphological characteristics.Deepening the understanding of the disease can improve the accuracy of pathological diagnosis and guide clinical treatment.