子宫平滑肌肉瘤与特殊类型良性平滑肌瘤的鉴别

The differential diagnosis between uterine leiomyosarcoma and the special subtypes of leiomyoma

目的 探讨鉴别子宫平滑肌肉瘤 (LMS)和特殊类型良性平滑肌瘤的高度敏感和特异的免疫组化指标。方法 选取子宫平滑肌肿瘤 82例 ,其中子宫平滑肌肉瘤 17例 ,富于细胞型平滑肌瘤2 5例 ,奇异型平滑肌瘤 15例 ,普通型平滑肌瘤 2 5例 ,用免疫组化SP法检测各组织中结蛋白、α平滑肌特异性肌动蛋白 (SMA)、调宁蛋白、重型钙调蛋白结合蛋白 (h caldesmon)、雌及孕激素受体、增殖细胞核抗原 (PCNA)、肥大细胞和CD4 4v3的表达。结果 虽然子宫LMS中结蛋白、SMA、h caldesmon、CD4 4v3的阳性表达率均低于富于细胞型或奇异型平滑肌瘤 (P <0 .0 5 ) ,但这些指标鉴别良、恶性子宫平滑肌瘤的意义有限。子宫LMS中雌、孕激素受体的阳性表达率和肥大细胞数均较富于细胞型或奇异型平滑肌瘤明显减少 ,但PCNA指数较后两者明显高 (P <0 .0 1)。结论 PCNA的增高和雌、孕激素受体的表达减少可用来辅助鉴别良、恶性子宫平滑肌瘤 ,用肥大细胞计数来鉴别诊断子宫LMS的灵敏度和特异性均较高。

Objective To explore the more sensitive and specific immunohistochemical markers in differential diagnosis of uterine leiomyosarcoma (ULMS) and the specific subtypes of leiomyoma. Methods The routine SP immunohistochemical technique was used to examine the expression of desmin, α smooth muscle actin (SMA), calponin h1, h-caldesmon, estrogen receptor (ER), progesterone receptor (PR), proliferating cell nuclear antigen (PCNA), mast cells, and CD44v3 in 82 patients with smooth muscle tumors of the uterus, including 17 patients with leiomyosarcoma (LMS), 25 with cellular leiomyoma (CL), 15 with bizarre leiomyoma (BL) and 25 with ordinary leiomyoma (OL). Results The expression rates of desmin, SMA, h-caldesmon and CD44v3 in uterine LMS were all lower than those in CL and BL(all P <0.05), but these markers had limited significance in differentiation of ULMS from CL or BL. Compared to those in CL or BL, the expression rates of ER and PR and the number of mast cells were significantly lower in LMS(all P <0.01), while the expression of PCNA in LMS was higher( P <0.01). Conclusion The increase of PCNA and decrease of ER and PR expression help differentiate ULMS from CL and BL. The number of mast cells was helpful in differential diagnosis of ULMS with high sensitivity and specificity.