子宫恶性潜能未定的平滑肌肿瘤42例临床病理分析

Clinicopathological analysis of 42 cases of uterine smooth muscle tumor of uncertain malignant potential

目的探讨子宫恶性潜能未定的平滑肌肿瘤(STUMP)的临床及病理特征。方法选取2013年10月至2021年10月于西北妇女儿童医院进行手术切除且最终病理诊断为STUMP的42例患者为研究对象,同时选取子宫平滑肌肉瘤(LMS)患者22例、子宫平滑肌瘤(LM)患者22例作为对照。采取回顾性分析法整理患者的临床资料及病理学特征,并探究联合免疫组化法对STUMP的诊断意义。结果42例STUMP患者肿瘤多位于子宫内,切面灰白灰黄色,质韧或较软,部分切面可见出血水肿、囊性变,镜下肿瘤细胞多呈束状、漩涡状排列,15例肿瘤细胞呈中-重度异型性,7例伴不确定类型或可疑肿瘤细胞凝固性坏死,9例核分裂象≥15个/10 HPFs,3例边界不清,10例伴上皮样或黏液样分化。3例STUMP患者在术后3年内复发。22例LMS患者中,p16、p53多呈弥漫强阳性表达,15例(68.2%)p16>40%,p53突变型17例(77.3%);同时WT-1多出现表达缺失,19例(86.4%)WT-1<10%,Ki-67≥10%为18例(81.8%),显示出较高的增殖活性。STUMP及LM患者中,p16、p53表达均较低,WT-1在STUMP中约半数出现表达缺失,而在LM中缺失率(13.6%)较低;STUMP及LM的Ki-67均较低,LM仅不到10%患者Ki-67≥10%,而STUMP中10例(23.8%)的Ki-67≥10%。结论STUMP的临床表现缺乏特异性,诊断标准尚未统一,病理诊断难度较大,联合免疫组化指标p16、p53、WT-1、Ki-67对诊断STUMP具有一定的临床意义。

Objective To investigate the clinical and pathological characteristice of uterine smooth muscle tumor of uncertain malignant potential(STUMP).Methods A total of 42 patients who underwent surgical resection and were finally diagnosed as STUMP in Northwest Women's and Children's Hospital from October 2013 to October 2021 were selected as the research objects.At the same time,22 patients with uterine leiomyosarcoma(LMS)and 22 patients with uterine leiomyoma(LM)were selected as controls.The clinical data and pathological characteristics of the patients were analyzed retrospectively,and the diagnostic significance of combined immunohistochemistry for STUMP was explored.Results The tumors of 42 patients with STUMP were mostly located in the uterus.The sections were gray white and gray yellow,tough or soft.Bleeding,edema and cystic changes were seen in some sections.Under the microscope,the tumor cells were mostly arranged in bundles and whirlpools.Tumor cells of fifteen cases showed moderate-severe atypia,7 cases had uncertain type or coagulation necrosis of suspicious tumor cells,9 cases had mitotic figure≥15/10 HPFs,3 cases had unclear boundary,and 10 cases had epithelioid or mucoid differentiation.Three patients with STUMP relapsed within 3 years after operation.Among the 22 patients with LMS,most of p16 and p53 showed diffuse strong positive expression,15 cases(68.2%)had p16>40%,17 cases(77.3%)had p53 mutation;the expression of WT-1 was mostly absent,19 cases(86.4%)had WT-1<10%,and 18 cases(81.8%)had Ki-67≥10%,showing higher value-added activity.In patients with STUMP and LM,the expression of p16 and p53 were lower,WT-1 was absent in about half of the STUMP,but the deletion rate(13.6%)was lower in LM;the Ki-67 of STUMP and LM were both lower,and less than 10%of LM patients had Ki-67≥10%,while 10 cases(23.8%)of STUMP had Ki-67≥10%.Conclusion The clinical manifestations of STUMP are lack of specificity,the diagnostic criteria have not been unified,and the pathological diagnosis is difficult.The combination of immunohistochemical indicators p16,p53,WT-1 and Ki-67 has certain clinical significance in the diagnosis of STUMP.