免疫组织化学标记在子宫内膜间质肉瘤诊断和治疗中的价值

 目的 探讨免疫组织化学标记在子宫内膜间质肉瘤（ESS）中的表达及其在诊断和治疗中的价值。方法 用免疫组织化学EnVision二步法对15例原发及3例转移复发ESS进行CD10、SM-MHC、h-caldesmon、AE1／3、CD99、Ki-67、CD34、c-kit、ER、PR的检测，并与其病理组织形态、临床并发症、鉴别诊断及预后对照。结果 17例CD10阳性，其中13例强阳性，7例伴平滑肌分化，3例伴上皮样分化，7例伴性索样分化；ER13例阳性，PR16例阳性； Ki-67 36 %～78 %。结论 子宫内膜间质肿瘤可伴多方向分化，主要为平滑肌和性索样分化；CD10是诊断子宫间质肿瘤的特异抗体，结合组织形态及SM-MHC、h-caldesmon等标记可增加其特异性；ER、PR常规检测主要用于指导孕激素辅助治疗。

Clinical value of immunohistochemistry in diagnosis and treatment of endometrial stromal sarcoma

Objective To investigate the expression and clinical value of immunohistochemistry in endometrial stromal tumors. Methods Immunohistochemical technique (Envision method) was applied to de－tect the expression of CD10, SM-MHC, h-caldesmon, AE1/3, CD99, Ki-67, CD34, c-kit, ER and PR in 15 cases of endomertrial stromal sarcoma and 3 metastases. The clinical pathological data ,including the histological characteristics,histochemical and immunohistochemical staining features, complication, differential diagnosis and prognosis of endometrial stromal tumours were analyzed. Results Among the 18 cases of endometrial stromal tumor, 17 cases had shown positive for CD10, including 13 cases diffuse positive and 4 muitifocal, 7 cases with smooth muscle differentiation, 3 cases with epithelial differentiation, 7 cases with sex-cord differ－entiation. 13 cases of ER and 16 cases of PR were positive expression in endometrial stromal sarcoma. Ki-67 in range 36 % ～ 78 %. Conclusion Endometrial stromal tumour can display multi-differentiation. They show various pathomorphological features, Smooth muscle and sex-coed differentiation, the most common types. CD10 can be expressed consistently in endometrial stromal tumors. CD10 with h-caldesmon and SM-MHC can be used to make differential diagnosis between the endometrial stromal tumors and cellular leiomyoma. ER and PR should be routinely estimated and be a prognostic predictor for endometrial stromal sarcoma