子宫出血性富于细胞性平滑肌瘤4例临床病理观察

目的探讨子宫出血性富于细胞性平滑肌瘤的临床病理特征，免疫学表型及鉴别诊断。方法分析4例子宫出血性富于细胞性平滑肌瘤的临床资料，观察常规HE切片的病理形态学特征，应用免疫组化SP法检测vimentin、desmin、SMA、CD10、LCA、ER、PR和Ki-67，并复习相关文献。结果患者主要临床特征是下腹部包块及腹痛。镜下以瘤细胞丰富、核固缩深染及出血、坏死为特征。免疫组化显示瘤细胞CD10和LCA均（-），vimentin呈弱（＋），desmin呈（＋），SMA呈局灶性强（＋）；在分化较好的瘤细胞中3例ER呈弱（＋），PR呈强（＋）；Ki-67增殖指数均〈1％。核固缩的瘤细胞中各种抗体均为（-）。结论子宫出血性富于细胞性平滑肌瘤是一种少见的平滑肌瘤类型，患者常有口服避孕药及与妊娠有关的病史，其镜下有独特的形态学特征。在做病理诊断时，应注意与子宫平滑肌肉瘤、子宫平滑肌瘤红色变性、子宫内膜间质肿瘤及子宫恶性淋巴瘤进行鉴别。

Hemorrhagic cellular leiomyomas of uterus: a clinicopathologic study of 4 cases

Objective To investigate the clinicopathologic features, immunophenotyping and differential diagnoses of hemorrhagic cellular leiomyomas of the uterus. Methods The clinicopathologic features and immunohistochemical findings were analyzed in 4 cases of hemorrhagic cellular leiomyomas of the uterus, with review of the literature. Results The main clinical features of these patients were a below abdominal mass and abdominal pain. Microscopically, the tumors were characterized by a dense cellularity, karyopyknosis, hemorrhage and necrosis. Immunohistochemical staining revealed that all cases were negative for CD10 and LCA. In 3 cases with well differentiated cells, ER was weakly positive and PR was strongly positive, whereas all cases were focally strongly positive for SMA and positive for vimentin and desmin, with a low Ki-67 index (<1%). In the karyopyknosis cells, all antibodies were negative. Conclusion Hemorrhagic cellular leiomyoma of the uterus is a rare type of leiomyomas and usually associated with history of oral contraceptives or pregnancy. Microscopically, there are characteristic morphologic features in the tumor. It needs to be distinguished from leiomyosarcoma, red degeneration of leiomyomas, endometrial stromal tumours and malignant lymphoma.