子宫颈黏液腺癌21例病理诊断分析

目的 对子宫颈黏液腺癌病理诊断过程的分析旨在为早期诊断、减少漏诊总结经验.方法 回顾性分析21例子宫颈黏液腺癌的病理诊断过程;采用LABC法免疫组化检测CEA及Ki-67的表达.结果 21例子宫颈黏液腺癌诊断中,漏诊3例(14.3%),其中1例为TCT漏诊,2例为子宫颈活检漏诊;4例(19.0%)子宫颈活检诊断为子宫颈原位腺癌、浸润不能除外,后经LEEP术确诊为子宫颈浸润性黏液腺癌;1例(4.8%)子宫颈活检诊断为慢性子宫颈炎,经LEEP术确诊为子宫颈浸润性黏液腺癌;12例(57.1%)直接由子宫颈活检确诊为子宫颈黏液腺癌;1例(4.8%)经诊刮诊断为腺癌,无法确定组织学类型,术后确诊为子宫颈黏液腺癌.免疫组化染色显示,其中10例CEA表达阳性(47.6%),Ki-67表达均升高(>20%).结论 从细胞学及组织形态学上,掌握子宫颈黏液腺癌的诊断要点,可以减少漏诊,及早做出正确的诊断,为患者赢得宝贵的手术时间.     

Endometrial stromal sarcoma with endometrioid adenocarcinoma of the uterus: a case report

Endometrial stromal sarcoma (ESS) is a rare malignant neoplasm of the uterus. We report the first case of undifferentiated ESS (UES) coexistent with grade 1 endometrioid adenocarcinoma in a 73-year-old female who presented with irregular vaginal bleeding for 4 days after menopause 20 years. Imaging examination including Magnetic Resonance Imaging (MRI) demonstrated multi-node reflection in uterine cavity without metastatic lesions, and the endometrium essentially normal. Grossly, a grey-red breakable polypoid tumor of 4.5 × 3.0 ×2.0 cm was recognized in the posterior uterine wall with surrounding slight rough endometrium. Microscopically, the tumor was composed of a larger component of undifferentiated stromal sarcoma that was distinct from a smaller endometrioid adenocarcinoma. The separate components of the tumor could be supported in immunohistochemical studies. There was no sign of recurrence for postoperative 6 months.     

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.     

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.     

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。     

子宫内膜间质肉瘤9例临床病理分析

目的 探讨子宫内膜间质肉瘤(endometrial stromal sarcoma,ESS)的临床病理特征、诊断、鉴别诊断及预后.方法 对9例ESS患者进行临床、病理资料分析、免疫组化检测及随访.结果 患者年龄39～64岁,中位46.3岁.临床主要表现为阴道流血及子宫增大/占位.肿瘤直径2.3～11 cm,平均4.6 cm.光镜下8例呈低度恶性子宫内膜间质肉瘤(low grade endometrial stromal sarcoma,LGESS),均由类似增殖期子宫内膜间质肿瘤细胞构成,细胞密集,异型性不明显,呈不规则舌状或岛状浸润肌层,并伴较多薄壁螺旋小血管;1例为高度恶性子宫内膜间质肉瘤/未分化子宫内膜肉瘤(high grade endometrial stromal sarcoma/undifferentiated endometrial sarcoma,HGESS/UES),肿瘤细胞直接替代子宫肌层,具有明显的细胞异型性,无LGESS常见的螺旋小血管.免疫组化检测显示肿瘤细胞CD10、vimentin均阳性,PR、ER大部分阳性,SMA和desmin及h-Caldesmon为极少数局灶阳性,S-100、CD34均阴性.术后随访7例(平均53个月),只有1例HGESS/UES死亡.结论 ESS是女性生殖道很少见的一种恶性肿瘤,恶性度相差很大.确诊主要依靠其临床病理特点,并辅以免疫组化标记综合分析.诊断时要与子宫内膜间质结节、平滑肌肿瘤、低分化癌等鉴别.     

子宫内膜间质肿瘤35例临床病理分析

目的 探讨子宫内膜间质肿瘤(endometrial stromal tumours, ESTs)的临床病理学特征,以期提高对ESTs的诊断和治疗水平.方法 回顾性分析35例子宫内膜间质肿瘤患者的临床及病理资料,部分辅以免疫组织化学染色分析.结果 患者平均年龄45岁,临床主要表现为子宫占位和阴道出血,35例ESTs中子宫内膜间质结节(endometrial stromal nodule, ESN)4例、低级别子宫内膜间质肉瘤(low-grade endometrial stromal sarcoma,ESS)26例、未分化子宫内膜肉瘤(undifferentiated endometrial sarcoma,UES)5例.ESN和ESS均由类似增生期子宫内膜间质的肿瘤细胞构成,并伴有丰富的螺旋小动脉,UES则具有明显的细胞异型性并缺乏螺旋动脉.18例辅以免疫组化标记的病例中17例CD10阳性,7例SMA局灶阳性,4例desmin局灶阳性.结论 ESTs是一组诊断可能具有困难的子宫间叶肿瘤,确诊依靠组织病理和一组免疫组化抗体标记,诊断上应与平滑肌肿瘤、PEComa等肿瘤相鉴别.     

卵巢类似性索-间质肿瘤子宫内膜样腺癌临床病理观察

目的探讨卵巢类似性索-间质肿瘤子宫内膜样腺癌(ovarian endometrial carcinoma resembling sex cord-stromal tumor,EC-SCS)的临床病理特征、免疫表型和鉴别诊断。方法对1例ECSCS进行HE和免疫组化SP染色,并复习相关文献。结果镜检:肿瘤90%以上区域由胞质透亮的梭形或短梭形细胞构成,其内混有实性条索状或中空小管样结构,类似Sertoli细胞肿瘤;仅有不到10%的区域表现为经典的子宫内膜样腺癌。免疫表型:肿瘤细胞弥漫表达CK、CK7、EMA、ER,不表达α-inhibin、PLAP以及CA125。结论 ECSCS与卵巢性索-间质肿瘤在形态上易混淆。在组织充分取材的基础上仔细寻找镜下经典的子宫内膜样腺癌的结构并结合免疫表型,有助于诊断。     

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.     

Minimal deviation endometrioid adenocarcinoma of the cervix: report of three cases with exfoliative cytology

Three histologically confirmed minimal deviation endometrioid adenocarcinomas (MDEA) of the uterine cervix with cytologic evaluation by cervical scraping were reviewed. The smears were cellular and showed tall columnar tumor cells arranged in monolayered sheets with nuclei in palisade at free borders, rosettes, and irregular clusters. Cellular strips with palisading nuclei was noted in one case. The individual tumor cells showed monomorphic, round or oval, hyperchromatic nuclei with chromatin clumping, small nucleoli, and granular, nonvacuolated cytoplasm with cytoplasmic extensions or tails. The smear background showed a variable amount of necrotic debris admixed with polymorphonuclear leukocytes in two cases. The cytologic manifestations of those three cervical MDEAs overlapped, to some extents, with those of a cervical adenocarcinoma in situ and with those of a well-differentiated endometrial adenocarcinoma invading the cervix.     

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.     

Oxyphilic cell variant of endometrioid adenocarcinoma

A case of oxyphllk cell variant of endometrlold adenocarclnorna is presented. To the best of our knowledge, there have been only three such cases reported in the English literature. The patient was a 35-yearold Japanese female (gravida 0, para 0). She was sllghtly obese with profuse vaginal bleeding. Histologlcal examlnation of the resected uterus revealed endometrlold adenocarcinoma with an exclusive oxyphllic cell component. There was no evidence of myornetrial Invasion nor lymph node metastases. Reported cases of oxyphilic cell varlant of endometrioid admocamlnoma, lncludlng the present case, were stages 0–1 and grades 1–2. Although further study is necessary to evaluate this variant, oxyphllk cell variant seems to be an early stage of ademcarcinoma and should be differentiated from eosinophllk mgtaplasia and other types of adenocarcinoma of the endometrium.     

Endometrial clear cell adenocarcinoma diagnosed by endometrial cytological examination: two cases report

In contrast to endometrioid endometrial adenocarcinoma (EA), endometrial clear cell adenocarcinoma (ECCA) is rare and shows a clinically aggressive potential, resulting in a poor prognosis. Therefore, the early diagnosis of ECCA is crucial for the treatment of patients bearing the tumor. Here, we report two cases of ECCA diagnosed by cytological examination. Case 1 was a 67-year-old female, while case 2 was a 68-year-old female. In both cases, tumors of the corpus uteri were identified, and they were diagnosed as ECCA on cytological examination with specimens derived from endometrial brushing. The diagnosis was confirmed by the histological examination of the surgical specimens.     

Endometrial adenocarcinoma: beliefs and scepticism

The incidence of endometrial adenocarcinoma is high in North America and northern Europe, and low in Asia and Africa. This variance in frequency rates occurred in the late 1970s and its real cause has remained in question since. There is a widespread belief that endometrial adenocarcinomas associated with endometrial hyperplasia have a much better prognosis than those related to endometrial atrophy. This view is, in general terms, true but only because a high proportion of tumors arising from an atrophic endometrium are of serous/papillary, clear cell, or Grade 2-3 endometrioid carcinomas, in contrast to those developing from a hyperplastic endometrium, which are nearly all G1 endometrioid adenocarcinomas. These adenocarcinomas have, however, an excellent prognosis, no matter whether they are related to hyperplasia or atrophy, and taxonomically they form a single tumor group. In this regard, it is most reasonable to separate endometrial carcinomas into low- and high-grade tumors. The first are formed solely of G1 or "authentic" endometrioid adenocarcinomas, i.e., endometrioid neoplasms composed in their entirety of glandular elements without having traces of nonsquamous solid components. The high-grade tumors are formed of both endometrioid Grade 2-3 adenocarcinomas and nonendometrioid carcinomas-all of particularly aggressive behavior. The question of grading endometrioid adenocarcinomas in a precise and reproducible way becomes obvious. It is also believed that endometrial adenocarcinomas associated with endometrial hyperplasia are estrogen-primed, while those related to endometrial atrophy are deprived of hormonal stimulation. However, as we have shown in this laboratory recently, estrogen stimulation may be very common in endometrial neoplasms developing in an atrophic endometrium. For indeed most, if not all, postmenopausal atrophic endometria harboring adenocarcinomas contain actively proliferating glands, with high Ki-67 proliferation index, high epidermal growth factor receptor (EGFR) activity, high microvessel density (MVD), and rich in estrogen and progesterone receptors (ER and PR), indicative of a continuous low-level estrogenic stimulation. That there is a number of endometrial carcinomas that tend to develop in a milieu of antiestrogenic domination, following treatment for breast carcinoma, this may well represent a form of breast-endometrial hereditary disease and, certainly, merits further investigation.     

原发性心脏恶性肿瘤9例临床病理分析

目的；分析原发性心脏恶性肿瘤（PCMT）的发病学特点、病理组织类型及形态学基础。方法：应用HE染色，组化及免疫组化标记对9例PCMT进行了形态学观察，并对其临床资料作了分析。结果：根据形态学发现和免疫组化结果，9例PCMI可分为心脏恶性间皮瘤（3例）、血管肉瘤（2例）、B细胞淋巴瘤（2例）、心包胸腺瘤（1例）及交界性上皮样血管内皮瘤（1例）。结论：PCMT和见，多于中年男性，好发于心房，多数恶性肿瘤预后差，肿瘤类型多，形态结构复杂，免疫组化标记对确定肿瘤起源很有帮助，早期发现、准确诊断与局部肿瘤全切除，对肿瘤的治疗和预后分析非常重要。     

子宫内膜癌microRNA表达谱的初步研究

目的 筛选子宫内膜癌与正常子宫内膜组织中的差异mieroRNA.方法 收集3例患者的新鲜子宫内膜癌组织及正常子宫内膜组织,利用miRNA芯片对其进行实验分析,并采用茎环逆转录荧光定量PCR方法验证芯片结果的准确性.结果 相对正常子宫内膜组织,子宫内膜癌组织中表达上调的miRNA基因68个,下调的miRNA基因81个.采用茎环逆转录荧光定量PCR对显著上调的hsa-miR-205,hsa-miR-200b和hsa-miR200c以及显著下调的hsa-miR-495,hsa-miR-216b的验证结果与芯片检测结果一致.结论 筛选获得了子宫内膜癌的miRNA的差异表达谱,可能在子宫内膜癌的发病机制中发挥潜在作用。