伴有假子宫内膜样小管的卵巢Sertoli-Leydig细胞肿瘤（假子宫内膜样Sertoli-Leydig细胞肿瘤）

卵巢子宫内膜样腺癌可显示各种形式的构型，非常类似于卵巢的性索一间质肿瘤，包括粒层细胞肿瘤、Sertoli细胞肿瘤和Sertoli—Leydig细胞肿瘤，这些类似于卵巢性索一间质肿瘤的子宫内膜样癌并已被人们认识。然而类似于子宫内膜样腺癌的卵巢性索一间质肿瘤还没有报道。作者报道了9例卵巢Sertoli—Leydig细胞肿瘤，肿瘤组织内均含有空的，有时扩张的小管，类似于子宫内膜样腺体，作者将这些结构称为假子宫内膜样小管。     

宫颈与宫体子宫内膜样腺癌的临床病理及免疫表型分析

目的探讨宫颈子宫内膜样腺癌和宫体子宫内膜样腺癌的临床病理和免疫表型差异。方法采用HE及免疫组化En-Vision两步法对8例宫颈内膜样腺癌和76例宫体内膜样腺癌的组织学形态和免疫表型进行比较观察。结果宫颈子宫内膜样腺癌和宫体子宫内膜样腺癌在组织学形态上相似。两组标本的免疫标记物阳性率分别为vimentin(0,95.45%)、CEA(100%,45.45%)、p53(12.50%,31.82%)、ER(0,54.54%)、PR(0,60.61%)、Ki-67(75.0%,12.12%)、HPV16/18(100%,3.03%)、p16(100%,46.97%)、Cam5.2(12.50%,62.12%)。两者相比,vimentin、CEA、ER、PR、p16、Ki-67、HPV16/18、PAS、Cam5.2的表达差异有显著性(P<0.05),而p53的表达差异无统计学意义(P>0.05)。结论应用免疫标记物vimentin、CEA、ER、PR、p16、Ki-67、HPV16/18、PAS、Cam5.2检测是鉴别宫颈和宫体子宫内膜样腺癌的一种重要的有效方法,p53可作为辅助鉴别的免疫标记物。     

卵巢黏液性囊腺瘤合并性索-间质肿瘤的临床病理观察

目的 探讨卵巢黏液性囊腺瘤合并性索-间质肿瘤(MCSC)的临床病理特点、组织起源及其诊断和鉴别诊断.方法 对1例MCSC进行组织形态学、免疫组化观察,并复习相关文献.结果 患者发现盆腔肿物1年,无明显不适及内分泌症状.大体上肿瘤为多房囊性,囊内壁可见散在的实性结节,镜检肿瘤由黏液性囊腺瘤和性索间质肿瘤两种成分组成,前者囊壁衬覆良性肠型黏液柱状上皮,性索间质成分瘤细胞呈小管状、条索状、梁状排列,局部有黄素化,两种成分混合存在,未见移行.免疫组化:性索成分瘤细胞呈Melan A弥漫强阳性;αInhibin和CD56局灶阳性;并见CKpan、vimentin、ER及PR的阳性表达;而EMA、CEA、CD99、S-100、CgA、Syn、nestin及SMA均阴性;Ki-67指数小于5%.结论 MCSC是罕见的卵巢肿瘤,性索间质成分可能是黏液性囊腺瘤囊壁内间质的一种反应性增生.诊断时需与类癌、伴异源成分的支持-间质细胞瘤、畸胎瘤等鉴别.     

子宫内膜间质肉瘤及双侧卵巢内膜样间质肉瘤1例

患者,41岁.2006年1月因阴道不规则出血伴腹痛2个月行诊刮术,病理报告为少量增生期子宫内膜伴子宫内膜间质增生,可见丰富的螺旋动脉,核分裂5～6个/10 HPF,由于组织破碎,与周围结构不清,目前难以判断良、恶性.术后患者常出现阴道不规则出血,多次B超及宫腔镜检查均见宫腔后壁占位,病理检查示子宫内膜间质细胞增生,但不能明确与周围组织的关系.近2个月出现下腹痛,2009年8月B超示宫腔占位,右侧附件混合型包块.2009年9月行手术治疗,术中切除右侧卵巢肿块送快速病理检查,诊断为子宫内膜间质肉瘤(endometrial stromal sarcoma,ESS).遂予扩大全子宫切除术+双侧附件切除术.     

p16在原发性卵巢黏液性和子宫内膜样肿瘤和转移性腺癌中的表达

原发性卵巢上皮性肿瘤与转移性腺癌的鉴别有时比较困难，特别是肿瘤显示黏液样、子宫内膜样或混合性子宫内膜样／黏液性分化时。伴有这些类型分化的转移性腺癌可来自于多个部位，如胃肠道和子宫（子宫内膜和宫颈）。大多数宫颈内膜腺癌显示黏液性和（或）宫内膜样分化，它们转移至卵巢比较少见，而且常表现为转移性癌的一些特征，如双侧卵巢累及，结节行生长。     

阴道原发性子宫内膜样腺癌

阴道的原发性腺癌约占阴道所有原发性癌15％。除了透明细胞腺癌认识较清楚外，其他类型的腺癌尚未得到足够的重视。作者报道了18例阴道原发性子宫内膜样腺癌，患昔年龄45—81岁，平均60岁。临床症状主要表现为阴道出血或不适。16例患者曾行子宫切除术，9例有子宫内膜异位症病史，5例有长期服用雌激素史，其中1例患者在诊断时还已服用三苯氧胺5年，1例患者在诊断腺癌之前9年曾被诊断为阴道腺病。肿瘤大小为1．4～7．0cm。     

子宫类似卵巢性索肿瘤的研究进展

Ⅱ型子宫类似卵巢性索肿瘤是发生在子宫的比较少见的肿瘤,由于对其组织学起源缺乏一致的认识,在WHO(2003)子宫体肿瘤分类中,将其作为独立的疾病归类在杂类肿瘤里,命名为性索样肿瘤.该文对该肿瘤的临床病理特点、免疫组化、超微结构、细胞遗传学、治疗及预后、组织来源及鉴别诊断等方面做如下介绍,以促进对该肿瘤的认识.     

一级子宫内膜样腺癌累及腺肌病临床病理分析

目的探讨子宫内膜一级子宫内膜样腺癌(endometri-oid adenocarcinoma,EA)累及腺肌病(adenomyosis,AM)的临床病理特点及鉴别诊断。方法观察2例子宫内膜一级EA累及AM的临床病理和免疫组织化学特点,并复习相关文献。结果 2例患者均为中年妇女,年龄分别为47、52岁,表现为进行性痛经伴月经量增多和经期延长,彩色超声示子宫内膜增厚、子宫增大伴肌壁间不均匀回声。病理检查:大体观察子宫增大,子宫壁增厚,子宫体底部子宫内膜局限型结节状和息肉状肿块。镜下为子宫内膜无肌层侵犯的一级EA,肌层内受癌累及AM腺体与子宫内膜EA形态一致,呈膨胀式扩张推挤周围平滑肌,肿瘤周边可见子宫内膜间质细胞;同时肌层内见未被癌累及的腺体和间质细胞。免疫组化:受癌累及的AM腺体周围及肿瘤周边子宫内膜间质细胞CD10(+),desmin(-)。结论一级EA累及AM确诊主要依靠组织学和免疫组化,病理诊断容易误诊为EA肌层侵犯或AM恶变,应引起注意。     

子宫内膜间质肉瘤和低分化子宫内膜样腺癌SMA、Desmin、ER、P53的病理分析对比

目的 探讨子宫内膜间质肉瘤和低分化子宫内膜样腺癌临床病理特征,以期提高鉴别和诊断的准确性.方法 回顾性分析2015年1月至2017年1月我院收治的30例子宫内膜间质肉瘤,以及30例低分化子宫内膜样腺癌患者,分别从巨检、镜检、免疫组化三方面进行病理分析与总结.结果 巨检结果发现,子宫内膜间质肉瘤肿块切面多数表现为灰白色,并且未发现明显细胞坏死现象.低分化子宫内膜样腺癌表面内膜粗糙、质脆,可见明显溃疡、出血坏死或肌层浸润现象.镜检结果发现,子宫内膜间质肉瘤呈现不规则舌状现象、肿瘤细胞排列密集,无核分裂或者核分裂不明显,血管周围肿瘤细胞呈现同心圆样排列.低分化子宫内膜样腺癌的腺体呈现多腺管状,腺体排列不规则,大小不一致,腺上皮细胞增生出现排列紊乱,并且增生细胞出现堆积现象,核分裂明显.免疫组化结果发现,低分化子宫内膜样腺癌ER表达阳性率高于子宫内膜间质肉瘤ER表达阳性率(100.00％＞ 66.67％),差异有统计学意义(P＜0.05).两组患者SMA、Desmin、P53表达阳性率之间无明显差别,差异无统计学意义(P＞0.05).结论 子宫内膜问质肉瘤和低分化子宫内膜样腺癌在巨检、镜检和免疫组化上可予区分.     

Uterine tumors resembling ovarian sex-cord tumors producing parathyroid hormone-related protein of the uterine cervix

A case of uterine tumors resembling ovarian sex-cord tumors (UTROSCT) producing parathyroid hormone-related protein (PTH-rP) of the uterine cervix is reported. A 66-year-old woman underwent total hysterectomy with bilateral salpingo -oophorectomy due to the possibility of a malignant uterine tumor. A fairly well-circumscribed tumor, measuring 8 x 5 x 7 cm, was present in the myometrium of the cervix and extended into the endocervical mucosa. Histologically, the tumor showed predominantly sex-cord-like differentiation and the features of conventional endometrial low-grade stromal sarcoma were observed in part. Immunohistochemically, the tumor cells were negative for CD10. From these findings, we diagnosed the present case as Clement and Scully's group II UTROSCT arising from the uterine cervix. To our knowledge, this is the first report of the cervical occurrence of UTROSCT. Furthermore, in this tumor, production of PTH-rP was demonstrated by normalization of serum PTH-rP after the tumorectomy and immunoreactivity for PTH-rP in the tumor cells.     

Ovarian endometrioid adenocarcinoma associated with steroidogenic foamy stromal cells

A case of a 69-year-old woman with endometriold adenocarcinoma of the ovary with functioning stromal cells is presented. The patient complained of genital bleeding. Endometrial curettage revealed endometrial hyperplasia. Preoperative levels of serum estradiol and progesterone were elevated, and serum gonadotropin levels were suppressed. The surgical specimen contained fist-sired, bilateral, solid, ovarian tumors and a mildly enlarged uterus. Histologically, the proliferating, atypical, columnar cancer cells resembled early secretory, endometrial epithelial cells with subnuclear vacuolation, and there were clusters of fat-laden foamy cells in the stroma. immunohistochemically, the cancer cells were positive for cytokeratin and progesterone receptor but negative for estrogen receptor. The stromal foamy cells were immunoreactive for vimentin, progesterone receptor, P450 side chain-cleavage, 3β-hydroxysteroid dehydrogenase, and adrenal 4-binding protein. immunoreactivities of P450c-17α hydroxylase and aromatase were only focally observed. These findings indicated that the stromal cells were steroldogenic and mainly produced progesterone. The cancer cells that expressed progesterone receptors showed morphologic changes in response to hormonal stimulation.     

Clinicopathologic study of endometrial dedifferentiated endometrioid adenocarcinoma: a case report

In 2006, dedifferentiated endometrioid adenocarcinoma (undifferentiated carcinoma associated with low-grade endometrioid carcinoma) of the uterus was first proposed. Dedifferentiated endometrioid carcinoma is part of the spectrum of undifferentiated carcinoma of the endometrium which is a highly aggressive tumor even when the undifferentiated component represents only 20% of the entire neoplasm. Therefore, accurate diagnosis and appropriate classification of this neoplasm are important in patient management. Lack of the recognition may lead to misclassification of dedifferentiated endometrioid adenocarcinoma as a pure endometrioid adenocarcinoma which is less aggressive. Only 4 papers have appeared in the literature so far on the topic of dedifferentiated endometrioid carcinoma. We report herein a first case of endometrial dedifferentiated endometrioid carcinoma in a 51-year old woman in Chinese population. We performed immunoperoxidase studies for 12 markers. Among them, cytokeratins, keratin 7, keratin 18, EMA, estrogen receptor (ER), progesterone receptor (PR), and vimentin show significantly differential expression between differentiated and undifferentiated area.     

Dedifferentiated endometrioid adenocarcinoma of the uterus: a clinicopathologic study of a case

Dedifferentiation confers more aggressive malignant behaviour than would be otherwise shown by the original tumor if present alone. This phenomenon has been described in several tumors, both mesenchymal and epithelial. Dedifferentiated endometrioid carcinoma either ovarian or endometrial is the latest addition to this family of tumors. Only 2 papers have appeared in the literature so far on the topic of dedifferentiated endometrioid carcinoma, both from the same institution. We report herein a case of endometrial dedifferentiated endometrioid carcinoma in a 45-year old lady with ovarian metastasis from the undifferentiated component. The primary endometrial tumor showed an undifferentiated component in an otherwise low grade endometrioid carcinoma. The undifferentiated component of these tumors can be misdiagnosed as the solid component of FIGO grade 3 in a pure endometrioid carcinoma. The recognition of an undifferentiated component in an otherwise low grade endometrioid carcinoma is very important, since dedifferentiated endometrioid adenocarcinoma has a worse prognosis when compared with FIGO grade 3 endometrioid carcinoma.     

Uterine tumor resembling ovarian sex-cord tumor with osteoid metaplasia

A rare uterine tumor showing sex-cord-like differentiation and marked osteoid metaplasia was found in a 33-year-old female. The tumor, occupying the uterine fundus, was multilobular, fleshy, and yellowish white, with punctations and poorly defined tumor margins into the subserosa. The tumor nodules were mostly composed of small, round, rather regular neoplastic cells with scanty cytoplasm and prominent nuclei. Epithelioid neoplastic cells with striking ovarian sex-cord-like arrangement, surrounded by fibrous tissue, were noticed. Polygonal neoplastic cells with marked osteoid metaplasia were also detected. The authors introduce an infrequent variant of uterine tumor resembling ovarian sex-cord tumor with osteoid metaplasia, probably of endometrial stromal cell origin. Because of deep myometrial infiltration without vascular invasion, malignant potential is considered. The patient is now alive without evidence of local recurrence or distant metastasis after abdominal total hysterectomy.     

Ductal (endometrioid) adenocarcinoma of the prostate: a clinicopathological study of 16 cases

Sixteen cases of ductal (endometrioid) carcinoma of the prostate are presented. The tumour presents in elderly men (age range 65–87 years) with haematuria or obstructive symptoms. Serum prostate specific antigen may be normal or raised. On cytoscopy, there is often an exophytic lesion in the region of the verumontanum. Histologically, two variants are recognized: papillary and cribriform, of which there were eight cases each. Eight cases consisted of pure ductal carcinoma and seven were mixed, containing a variable proportion of micro-acinar carcinoma.The associated micro-acinar carcinoma had a Gleason score of at least 5. One case of carcinosarcoma with a ductal epithelial component was also included. All cases displayed positive immunohistochemical staining for prostate specific antigen and prostatic acid phosphatase and but were negative for the basal cell marker MA903. The tumour responds well to orthodox micro-acinar carcinoma therapy and appears notably sensitive to hormonal manipulation. Follow-up of the mixed group is restricted to a maximum of 3 years. Of the eight pure cases, five patients are still alive with survival periods of 11, 8, 7, 3 and 1 years. Three patients died of intercurrent disease of which one patient survived 12 years, having received no treatment. This tumour, therefore, can be regarded as having a good prognosis.     

Minimal deviation endometrioid adenocarcinoma of cervix: a clinicopathological and immunohistochemical study of two cases

We describe the clinicopathological features of two cases of minimal deviation endometrioid adenocarcinoma of cervix. This is a rare tumour whose predominant pattern is one of bland endometrial-type glands infiltrating the cervical wall without a stromal response. Thus, it may be confused with benign conditions such as cervical endometriosis. The two cases demonstrate that this tumour may behave aggressively despite its bland appearances. An immunohistochemical study was performed and showed only focal reactivity of neoplastic glands for carcinoembryonic antigen, which would limit its diagnostic use in small biopsy specimens.     

Prostatic duct adenocarcinoma with endometrioid features: immunohistochemical and electron microscopic study

Despite earlier arguments that the so-called "endometrioid carcinoma" is of Müllerian remnant origin, our clinicopathologic study of 35 cases indicated that it is actually an adenocarcinoma of prostatic duct origin. With respect to histology, it has two growth patterns; type A, an exuberant papillary endometrioid pattern with a focal intraductal component, and type B, less papillary-endometrioid growth and more intraductal components. Immunoperoxidase study showed immunoreactivity for prostatic-specific antigen and prostatic acid phosphatase in all 20 cases tested. Ultrastructural study identified prostatic epithelial cells rather than ciliated endometrial features. In 18 of 35 cases, we identified microacinar carcinoma of the prostate, MDAH grade I, Gleason's combined score 2, 3, or 4. Twenty-two treated patients presented with obstruction, hematuria, or both; 20 had stage C or D disease, suggesting that this tumor is more aggressive than was originally assumed.