绝经后子宫内膜癌癌周内膜病理学特征及其与预后的关系

目的：研究绝经后子宫内膜癌癌周内膜的病理学特点及其与预后的关系。方法：根据癌周内膜的组织学表现分为增生型和萎缩型两组，对２０４例子宫内膜癌患者的临床与病理特点和长期随访结果进行回顾性分析。结果：癌周内膜呈增生型的子宫内膜癌患者伴发高血压、肥胖、糖尿病、不孕及子宫内膜增生过长史的机率显著高于癌周内膜呈萎缩型的子宫内膜癌患者（Ｐ＜０．００１）；具有较高恶性程度的非内膜样腺癌（包括透明细胞型腺癌、鳞腺癌、浆液型腺癌）在癌周内膜呈萎缩型组占２７．０％，在增生型组占５．５％（Ｐ＜０．００１）。癌周内膜呈萎缩型者较增生型者呈低分化倾向及深肌层、脉管浸润（Ｐ＜０．００１）；５年生存率，癌周内膜呈增生型子宫内膜癌患者为９６．７％，萎缩型为８６．２％（Ｐ＜０．０１）。结论：子宫内膜癌癌周内膜的病理学特征与预后相关，癌周内膜呈增生型者的预后好于萎缩型。     

不孕症1156例的子宫内膜病理与临床研究

目的探讨女性不孕症患者子宫内膜组织形态结构和临床表现特点及鉴别诊断。方法对1156例女性不孕症患者的子宫内膜病理检查结果和临床资料进行回顾性研究。结果1：156例不孕症患者年龄21～41岁，平均25．8岁；不孕时间1～13年，平均2．9年。晚期分泌期子宫内膜161例(13．9％)，分泌不良型子宫内膜724例(62．6％)，增生期子宫内膜223例(19．3％)，子宫内膜不规则增生反应29例(2．5％)，子宫内膜增生过长14例(1．2％)，结核性子宫内膜炎5例(0．4％)。全部病例中伴随有子宫内膜息肉发生者97例(8．4％)。结论子宫内膜病理检查在不孕症的病因分析及诊断中具有较为广泛的应用价值。     

VCE取材 TBS报告对子宫内膜癌卵巢癌诊断的价值

目的 探讨VCE取材[取材顺序：阴道侧壁上1／3(V)、宫颈鳞-柱细胞交界处(C)、宫颈管(E)]、TBS描述性报告对诊断子宫内膜癌、卵巢癌的重要性。方法 1998年6月至2003年5月对4840例门诊患者进行妇科细胞学检查，行VCE取材、TBS描述性报告与以往单纯宫颈刮片、巴氏5级报告对比，并对部分报告异常的患者跟踪随访。结果 4840例患者检出子宫颈鳞癌50例(占1．03％)、腺癌15例(占0．31％，包括宫颈腺癌10例、子宫内膜癌4例、卵巢癌1例)，检出重度鳞状上皮内病变30例(占0．62％)、轻度鳞状上皮内病变43例(占0．89％)、不典型鳞状细胞性质未定45例(占0．93％)、不典型腺细胞性质未定6例(占0．12％)、炎症3653例(占75．48％)、正常998例(占20．62％)。结论 VCE取材、TBS描述性报告与单纯宫颈刮片、巴氏5级报告对比，此方法除了在子宫颈癌及癌前病变的早期筛查有重要意义之外，对子宫内膜癌、卵巢癌的诊断也起着重要的辅助作用。     

子宫内膜不典型增生及其处理

1　子宫内膜不典型增生子宫内膜不典型增生 (atypicalhyperplasia ,AH)是一个组织病理学名称 ,属子宫内膜增生的一种类型 ,其主要的病理学特征为腺上皮细胞出现异型性。根据Kuman为首的美国学者通过对 170例未治疗的子宫内膜增生患者进行 1 2 5年随诊的结果为基础 ,1987年国际妇科病理协会 (IS GP)提出将子宫内膜增生分为 :①单纯性增生 ;②复合性增生 ;③不典型增生 3大类 ,该分类法目前已被国内外普遍采用。其中子宫内膜不典型增生根据增生腺体是否出现背靠背群集 ,分为简单性不典型增生和复杂性不典型增生 ;根据组织学病变程度不同又…     

整合素α~6和β_4亚单位在人类月经周期和早孕时子宫内膜中的表达

目前认为,整合素在子宫内膜中参与调节细胞与细胞之间及细胞与间质之间的相互反应。本研究通过单克隆抗体免疫组化法,了解整合素α~6和β~4亚单位在月经周期和早孕子宫内膜表面和腺上皮表达。32例妇女(平均年龄34.14±3.4岁)分成两组,A组13例,孕6周～孕9周自愿要求人工流产时取子宫内膜;B组19例非妊娠者因妇科疾患需行宫腔镜下活检、子宫内膜诊刮或子宫切除时取子宫内膜。B组子宫内膜分为三期,植入前期(7例):病理学检查表现为增生期至排卵后3天之间;植入期(6例):病理学枪查表现为排卵后4天至排卵后9天之间;植入后期(6例):病理学检查表现为排卵后10天至排卵后14天之间。所有子宫内膜切片行单克隆抗体免疫组化染色。     

临床多选题

〔A 型题〕问36:子宫内膜癌的癌前病变是指:A 晚期增生期子宫内膜B 萎缩型子宫内膜C 子宫内膜腺囊型增生D 子宫内膜腺瘤型增生E 子宫内膜不典型增生问37:子宫内膜癌的最可靠的诊断方法是:A 宫腔吸液细胞学检查B 后穹窿取材涂片细胞学检查C 宫腔碘油造影     

子宫内膜腺鳞癌临床病理特征及其预后研究

目的 探讨子宫内膜腺鳞癌患者的临床病理特征及预后。方法 选取1992年3月至2004年12月北京大学人民医院就诊的子宫内膜癌患者,分为普通子宫内膜样腺癌组、腺鳞癌组以及浆液性乳头状腺癌和透明细胞癌组进行回顾性研究。结果 腺鳞癌患者9例,占同期210例内膜癌患者的4.3%。普通子宫内膜样腺癌组与腺鳞癌组肿瘤分期差异无显著性意义（P〉0.05）;浆液性乳头状腺癌和透明细胞癌患者肿瘤分期明显晚于子宫内膜样腺癌患者（P〈0.05）。腺鳞癌组深肌层及浆膜层浸润较普通子宫内膜样腺癌组多,分别为6/9和32.6%（62/190）,但差异无显著性意义（P〉0.05）。腺鳞癌组与普通子宫内膜样腺癌组患者肿瘤细胞分化程度差异无显著性意义（P〉0.05）。18例（9.5%）普通子宫内膜样腺癌患者、1例（1/9）腺鳞癌患者以及4例（4/11）浆液性乳头状腺癌和透明细胞癌患者因癌死亡,子宫内膜样腺癌患者因癌死亡比例明显低于浆液性乳头状腺癌和透明细胞癌患者（P〈0.05）,而普通子宫内膜样腺癌组与腺鳞癌组差异无显著性意义（P〉0.05）。生存分析显示接受手术治疗的腺鳞癌患者,其预后与肿瘤分期相关（P〈0.05）。结论 子宫内膜腺鳞癌临床病理特征及预后与普通子宫内膜样腺癌无明显区别,而与浆液性乳头状腺癌和透明细胞癌不同。     

子宫内膜非典型增生与浸润性内膜癌

子宫内膜非典型增生范围不一,又缺乏一个统一的分类使得临床医师处理增生病变较困难,而且子宫内膜增生发展为癌发生率不清。为评估子宫内膜典型增生与子宫内膜癌的关系,选择44例标本:腺癌19例(43％),有内膜增生20例(45％),已无内膜增生5例(10％)。19例腺癌中17例侵犯肌层,7例为Ic或更高。癌患者1/3在50岁以下,70岁以上组合并腺癌较多。上述三组平均年龄无重大差别。30     

宫外孕287例子宫内膜的病理分析

目的 探讨宫外孕患者子宫内膜组织形态特点及鉴别诊断。方法 对287例宫外孕子宫内膜组织进行病理形态学观察分析。结果 287例宫外孕患者年龄17～43岁，平均25岁。蜕膜组织96例(33．4％)，子宫内膜腺体高度分泌反应及A-S反应15例(5．2％)，蜕膜组织和腺体高度分泌反应及A-S反应42例(14．6％)，子宫内膜呈分泌性反应78例(27．2％)，子宫内膜呈增生性反应9例(3．1％)，子宫内膜呈分泌和增生双相反应32例(11．1％)，子宫内膜不规则脱卸15例(5．2％)。结论 宫外孕子宫内膜组织形态结构具有多种表现和类型。     

肾上腺髓质素及其降钙素受体样受体与子宫内膜腺癌微血管密度的相关性

目的探讨肾上腺髓质素(AM)及其受体——降钙素受体样受体(CRLR)在子宫内膜腺癌组织中的表达与子宫内膜腺癌微血管密度(MVD)的相关性。方法免疫组化法检测2006年1月至2010年1月中国医科大学附属第一医院以及解放军202医院收治的15例子宫内膜单纯性增生、21例子宫内膜不典型增生、50例子宫内膜腺癌组织中AM及CRLR蛋白表达;利用CD34免疫组化法检测组织内MVD,并研究与临床病理学参数的关系。结果 AM在子宫内膜腺癌中的表达高于单纯性增生组织(P<0.05);CRLR蛋白在子宫内膜腺癌中的表达高于单纯性增生、不典型增生组织(P<0.05);在子宫内膜腺癌中,AM与CRLR的蛋白表达呈正相关(r=0.399,P=0.004),AM与CRLR的表达均与肿瘤的MVD呈正相关(P<0.05)。结论 AM及其受体CRLR与子宫内膜腺癌的发生有关,并且参与肿瘤的血管发生。     

高分化子宫内膜样癌及子宫内膜重度不典型增生患者孕激素治疗的临床分析

目的探讨35岁以下高分化子宫内膜样癌及子宫内膜重度不典型增生患者采用孕激素治疗以保留患者子宫的疗效,并随访其治疗后的生育情况.方法采用回顾性分析的方法对1991年至2005年北京协和医院收治的35岁以下、接受孕激素治疗（以醋酸甲羟孕酮为主）的25例高分化子宫内膜样癌及子宫内膜重度不典型增生患者的临床病理资料进行研究.其中,子宫内膜样癌8例（内膜癌组）,子宫内膜重度不典型增生17例（不典型增生组）.孕激素治疗前对患者进行全面的分期评估,治疗后每1～6个月诊刮以评价疗效,对有生育要求者随访其生育情况.结果内膜癌组患者孕激素治疗前经全面的分期评估,证实为早期、高分化子宫内膜样癌.除1例子宫内膜样癌患者尚未评估疗效外,内膜癌组其他7例及不典型增生组17例患者治疗后有效者分别为6例（6/7）、17例（100%）;缓解者分别为5例（5/7）、14例（82%）;缓解后复发者分别为1例（1/5）、3例（21%）,复发时间为缓解后6～30个月;随访缓解后要求生育的14例患者中,内膜癌组4例患者尚未生育,不典型增生组10例患者中4例妊娠共7次.1例自然受孕后失访;3例经促排卵治疗后受孕并足月分娩,其中1例产后人工流产3次.结论对于要求保留子宫的高分化子宫内膜样癌及子宫内膜重度不典型增生的年轻患者,孕激素治疗是一种治疗选择.孕激素治疗前应对子宫内膜样癌患者进行详细全面的分期评估,辅助生殖措施的介入有望提高治疗后的妊娠率.     

子宫内膜癌γ-synuclein表达和血清CA125水平及与临床病理特征关系的研究

目的:研究乳腺癌基因1(γ-synuclein)表达和血清癌抗原125(CA125)水平及与子宫内膜癌临床病理特征的关系,探讨其在子宫内膜癌发生发展中的作用及对病情评估的意义。方法:采用免疫组化SP法检测50例子宫内膜样腺癌(子宫内膜癌组)、14例子宫内膜不典型增生(子宫内膜不典型增生组)、12例正常子宫内膜(对照组)组织中γ-synuclein的表达,用化学发光免疫分析法检测患者血清CA125的水平。结果:γ-synuclein阳性表达在子宫内膜癌组、子宫内膜不典型增生组及对照组间比较,差异有高度统计学意义(χ2=10.379,P<0.01),其中,γ-synuclein在子宫内膜癌组及子宫内膜不典型增生组中的阳性表达均显著高于对照组(P均<0.01)。在子宫内膜癌组γ-synuclein表达与临床分期、肌层浸润深度有关(P<0.05,P<0.01)。子宫内膜癌组血清CA125水平阳性率显著高于对照组及子宫内膜不典型增生组(χ2=7.040,P<0.01)。γ-sy-nuclein、血清CA125之间无相关性(r=0.201,P>0.05)。结论:γ-synuclein的表达与子宫内膜癌发生发展及侵袭有关,可能作为预后指标;血清CA125水平可能预示子宫内膜癌的恶性程度。     

Expression of cyclin D1 in normal,hyperplastic and neoplastic endometrium and its correlation with Ki-67 and clinicopathological variables

Methods We investigated cyclin D1 expression in proliferative endometrium, endometrial hyperplasia and endometrioid adenocarcinoma, and examined the correlation of cyclin D1 expression with Ki67 as a cell proliferation associated marker. Immunohistochemical expression of cyclin D1 and Ki67 were studied in 30 cases with endometrial carcinoma, 14 cases with atypical hyperplasia, 15 cases with simple hyperplasia and 30 cases with proliferative endometrium.Results One out of 30 patients (3.3%) with proliferative endometrium, 1 out of 14 patients (7.1%) with atypical hyperplasia, and 8 out of 30 patients (26.6%) with endometrial carcinoma were found to have immunoreactivity to cyclin D1. All cases of simple hyperplasia had negative staining for cyclin D1. A positive immunoreaction for Ki67 was obtained in all cases. Statistically significant difference was found in cyclin D1 immunoreactivity between both proliferative endometrium and adenocarcinoma, and simple hyperplasia and adenocarcinoma (p<0.05). In patients with adenocarcinoma, cyclin D1 immunoreactive cases had higher mean Ki67 values compared with the non-immunoreactive ones (p<0.05). Ki67 and cyclin D1 immunoreactivity had no impact on overall survival. Univariate analysis revealed a significant relationship between survival and grade and stage (p<0.01). Cyclin D1 expression was not correlated with age, depth of myometrial invasion, lymphovascular space involvement, grade, lymph node metastasis and stage.Conclusion Cyclin D1 expression in endometrial carcinoma is higher than proliferative endometrium and simple hyperplasia. These findings support that cyclin D1 may play a role in endometrial carcinogenesis.     

p16、Cyclin D1在增生性子宫内膜及子宫内膜癌中的表达

目的 :探讨 p16和 Cyclin D1在内膜癌发生、发展中的作用。方法 :采用免疫组化 S—P法对 12例正常子宫内膜、2 2例增生性子宫内膜及 4 1例子宫内膜癌中 p16和 Cyclin D1表达进行了研究。结果 :在单纯加复合增生、不典型增生及子宫内膜癌中 ,p16表达呈下降趋势 ,内膜癌与正常内膜及增生性内膜有显著性差异 (P<0 .0 1,P <0 .0 5 ) ;而Cyclin D1表达呈上升趋势 ,增生性子宫内膜、子宫内膜癌与正常内膜有显著性差异 (P<0 .0 5 ,P<0 .0 1)。不典型增生与单纯加复合增生 Cyclin D1过表达有显著性差异 (P<0 .0 1)。子宫内膜癌中 ,p16表达随细胞分化程度下降而降低 ,而Cyclin D1则随分化程度下降而上升 ,二者呈负相关。结论 :p16、Cyclin D1异常参与子宫内膜癌的发生 ;p16低表达、Cyclin D1过表达与内膜癌的恶性生物学行为有关 ;Cyclin D1核过表达可能是一个早期分子事件     

子宫内膜癌DNA错配修复基因hMLH_1表达的研究

目的:探讨DNA错配修复基因hMLH1的表达与子宫内膜癌的关系。方法:选取1981年1月至2001年12月在天津医科大学总医院住院手术子宫内膜癌104例和正常子宫内膜35例(其中增生期17例,分泌期18例)及子宫内膜不典型增生8例,用免疫组化SABC法检测组织中hMLH1基因蛋白产物的表达,并对hMLH1蛋白表达与子宫内膜癌临床病理特征的关系进行了分析。结果:子宫内膜癌、子宫内膜不典型增生、正常子宫内膜增生期和分泌期hMLH1表达缺失率分别为64.4%、37.5%、11.8%和5.6%。子宫内膜癌组织中hMLH1的表达缺失率明显高于正常子宫内膜组织(P=0.0001);子宫内膜样腺癌、腺癌伴鳞状上皮分化、透明细胞癌和浆液性癌hMLH1表达缺失率分别为68.9%、50%、25%和0,在子宫内膜样腺癌中hMLH1基因表达缺失率明显高于其他组织学类型(P=0.02,P=0.003)。hMLH1基因表达缺失者5年生存率明显高于阳性表达者(P=0.012),遗传性子宫内膜癌、非特异肿瘤聚集性子宫内膜癌及散发性子宫内膜癌hMLH1蛋白表达缺失率分别为100%、94.1%及55%,遗传性及非特异肿瘤聚集性子宫内膜癌hMLH1基因表达缺失率明显高于散发性子宫内膜癌(P=0.02,P=0.003)。结论:hMLH1基因表达缺失与子宫内膜癌和子宫内膜不典型增生发生有关。hMLH1基因表达缺失与子宫内膜癌组织学类型中的子宫内膜样腺癌有关,hMLH1基因表达缺失者预后较好,且在遗传性子宫内膜癌患者中表达缺失率明显高于散发病例。     

The value of curettage in diagnosis of endometrial hyperplasia.

OBJECTIVES: The aim of this study was to assess the value of diagnosis of endometrial hyperplasia by curettage and to determine the results of proliferating cell nuclear antigen (PCNA) immunostaining in differentiating endometrial carcinoma from endometrial hyperplasia. METHODS: According to Kurman's criteria, we treated 150 patients with endometrial hyperplasia detected by curettage and compared retrospectively the diagnosis by curettage with that by hysterectomy. PCNA expression was examined using immunohistochemostaining on 60 patients with complex atypical hyperplasia detected by curettage. RESULTS: Simple hyperplasia was found by curettage in 53 patients, complex hyperplasia in 11, simple atypical hyperplasia in 26, and complex atypical hyperplasia in 60. All patients were rediagnosed after hysterectomy. As a result, 65 were found to have simple hyperplasia, 7 complex hyperplasia, 15 simple atypical hyperplasia, 29 complex atypical hyperplasia, and 34 endometrial carcinoma. The accuracy of histological diagnosis by curettage was 76.7-92.0% and was dependent on different types of hyperplasia. Simple atypical hyperplasia and complex atypical hyperplasia were more likely to coexist with endometrial carcinoma than both simple hyperplasia and complex hyperplasia (chi2 = 26.3, P < 0.001), and complex atypical hyperplasia was more likely to coexist with endometrial carcinoma than simple atypical hyperplasia (chi2 = 9.78, P < 0.005). In complex atypical hyperplasia patients, coexistence with endometrial carcinoma was more common after menopause than before menopause (chi2 = 3.93, P < 0.05). In complex atypical hyperplasia patients, the expression of PCNA in cases associated with endometrial carcinoma was higher or stronger than in cases associated without endometrial carcinoma (chi2 = 7.68, P < 0.01, or U = 252.00, P < 0.01). Conclusions. Curettage tends to be more highly accurate in diagnosing simple hyperplasia than complex atypical hyperplasia, which is often found by hysterectomy to be associated with endometrial carcinoma. The expression of PCNA may be helpful in differentiating complex atypical hyperplasia from endometrial carcinoma.     

子宫内膜癌PTEN蛋白表达及其临床意义

目的 :探讨抑癌基因第 10染色体同源丢失性磷酸酶 -张力蛋白基因 (PTEN)蛋白表达与子宫内膜癌的发生、发展及复发的关系。方法 :采用免疫组织化学S P法检测PTEN蛋白在 5 0例子宫内膜癌、12例不典型增生子宫内膜及 10例正常子宫内膜组织的表达。结果 :5 0例子宫内膜癌中PTEN蛋白表达率为 5 6 0 0 % ,明显低于正常子宫内膜以及不典型增生子宫内膜中的表达 (10 0 0 0 %、91 0 0 % ) (P <0 0 5 )。PTEN蛋白在无肌层浸润或肌层浸润≤ 1/ 2的子宫内膜癌中阳性表达率为 76 0 0 % ,肌层浸润 >1/ 2或有淋巴结转移者为 36 0 0 % ,与肌层浸润程度显著相关 (P <0 0 5 ) ,且Ia Ib期与Ic期相比也有统计学差异 ;但与子宫内膜癌的组织学分级、有无复发无关 (P >0 0 5 )。结论 :抑癌基因PTEN蛋白表达缺失在子宫内膜癌的发生、发展、浸润及复发过程中有一定作用。     

Which surgical procedure for patients with atypical endometrial hyperplasia?

OBJECTIVE: To determine the occult coexistence of endometrial carcinoma in patients with atypical endometrial hyperplasia and to compare histological prognostic factors according to lymph node status in occult endometrial carcinoma. MATERIALS AND METHODS: Two hundred and four patients from two referral centers (during the period 1990-2003) who were operated on within 1 month of endometrial biopsy for symptomatic endometrial hyperplasia without receiving any medical treatment were included retrospectively. Patients having preoperative endometrial biopsy results of concomitant endometrial hyperplasia and carcinoma were excluded from the study. Fifty-six patients having atypia in preoperative biopsy (group I) were compared with 148 patients without atypia (group II). Chi-square and Mann-Whitney U-tests were used for statistical analyses. RESULTS: No significant difference was observed between the two groups according to age or menopausal status. Patients in group II had significantly higher parity than patients in group I. In group I, 62.5% of the patients had endometrial carcinoma, 21.4% had endometrial hyperplasia, and 16.1% had normal endometrium in hysterectomy specimens. In group II, the percentages were 5.4, 38.5, and 56.1%, respectively. Complete surgical staging was performed in 20 patients. Four patients had metastatic lymph nodes. All of them had grade 2 tumors with lymphovascular space involvement. Three of them had nonendometrioid tumors. CONCLUSION: Careful intraoperative and preoperative evaluation of the endometrium must be the sine qua non for patients with atypical endometrial hyperplasia. It is reasonable to do frozen section at the time of hysterectomy for atypical endometrial hyperplasia, and if grade 2/3 of nonendometrioid cancer with lymphovascular space involvement is found, complete surgical staging should be performed.     

Endometrial hyperplasia and carcinoma in endometrial polyps: clinicopathologic and follow-up findings.

The objectives of this study were: 1) to evaluate findings in follow-up hysterectomy specimens after a diagnosis of complex atypical hyperplasia or carcinoma in endometrial polyps (EMPs) for possible significance in management strategies; and 2)to identify features in these polyps, that are predictive of the presence of endometrial hyperplasia or carcinoma in subsequent hysterectomy. Records of all cases of EMPs with endometrial hyperplasia were retrieved from the files of New York University Medical Center from 1993 to 2005. Those cases with follow-up hysterectomy were selected for the study. Of the 29 patients with complex atypical hyperplasia within the polyp, 19 out of 29 (66%) patients had hyperplasia of the non-polyp endometrium, and adenocarcinoma was observed in 9 out of 29 (31%) patients on follow-up hysterectomy. The percentage of polyp area involved by the hyperplasia was predictive of finding endometrial disorder in subsequent hysterectomy (P = 0.005). Of the 8 patients with adenocarcinoma in situ (AIS) within the polyp 3 (38%) had myoinvasive adenocarcinoma. In contrast, in cases without AIS, 4 out of 21 (19%) had myoinvasive adenocarcinoma in follow-up hysterectomy. Eight of the nine cases with carcinoma in endometrial polyp had endometrial pathology on hysterectomy. Approximately two thirds of the patients with hyperplasia and 90% of patients with adenocarcinoma in endometrial polyps show endometrial pathology on subsequent hysterectomy. The above findings reinforce the need for hysterectomy especially in postmenopausal women with atypical complex hyperplasia or carcinoma in endometrial polyps even if these changes appear confined to the polyp in initial sampling.