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。     

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。     

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。     

对p16 蛋白鉴别子宫颈内膜腺癌与子宫内膜腺癌的新认识

子宫内膜癌是女性生殖系统常见恶性肿瘤。许多子宫颈内膜腺癌也可以表现为宫内膜样分化，因而两者有时在形态上非常相似，单纯利用活检和刮除术标本决定子宫腺癌的来源是很困难的。有时肿瘤原发灶包含子宫下段和宫颈，因缺乏明显的前期病变，即使在子宫切除术后标本中也难以将二者区别开来。然而，由于两者手术术式的不同，鉴别诊断很重要。     

子宫内膜样腺癌中ARID1A蛋白的表达及意义

目的探讨ARID1A蛋白表达与子宫内膜样腺癌发生、发展的关系。方法采用免疫组化SP法检测子宫内膜的增生期、分泌期、孕期、简单性增生、复杂性增生、不典型增生和子宫内膜样腺癌中ARID1A蛋白的表达,分析其表达与临床病理特征及生存期的相关性。结果子宫内膜的增生期、分泌期、孕期、简单性增生及复杂性增生组织中ARID1A蛋白均呈阳性;子宫内膜不典型增生和子宫内膜样腺癌组织中ARID1A蛋白缺失率分别为8.33%(3/36)和41.51%(44/106),较不伴不典型增生的子宫内膜显著升高,子宫内膜样腺癌的ARID1A蛋白缺失率较不典型增生显著升高(χ2=13.358,P0.01);子宫内膜样腺癌的ARID1A蛋白缺失率与病理组织学分级呈负相关(P0.05)。ARID1A蛋白缺失率与患者年龄、是否绝经、子宫体肌层浸润深度、FIGO分期、淋巴结转移及生存期无关。结论 ARID1A蛋白缺失是子宫内膜样腺癌发生的早期事件,在子宫内膜样腺癌发生过程中具有重要作用,而对子宫内膜样腺癌进展的作用不明显。     

子宫峡部内膜腺癌14例临床病理分析

目的探讨子宫峡部内膜腺癌（uterine isthmic endometrial adenocarcinoma,UIE）的临床病理特征、生物学行为及预后。方法回顾性分析14例UIE临床病理资料,总结其大体、组织学、免疫组化及预后特点,并与63例子宫体内膜腺癌（uterine corpus endometrial adenocarcinoma,UCE）相比较。结果UIE病灶中心在子宫峡部,仅有局部宫颈上端及宫体下端的蔓延。子宫峡部肿块呈外生性息肉状或内生浸润性生长,直径1.5～4cm;9例（64．3％）UIE浸润深肌层（〉50％）,其中4例浸润达浆膜。组织学上,1例为透明细胞型,2例为鳞腺癌,11例为子宫内膜样型;11例（78.6％）UIE为高级别（7例G2、4例G3）。UIE患者的临床分期,Ⅰ期1例（7．1％）,Ⅱ期8例（57.2％）、Ⅲ期4例（28,6％）及Ⅳ期1例（7.1％）。UIE与UCE在浸润深肌层、组织级别、临床分期及淋巴管浸润上差异有显著性;而ER、PR及p53的表达在UIE与UCE之间差异无显著性。结论子宫峡部内膜腺癌是少见的,临床病理及生物学行为与UCE不同。UIE是独立的预后差的子宫内膜腺癌。     

息肉样子宫内膜异位症临床病理分析

目的探讨罕见的息肉样子宫内膜异位症的临床病理特征及鉴别诊断。方法对1例息肉样子宫内膜异位症进行病理学和免疫组化染色观察,复习相关文献。结果患者35岁,阴道、子宫颈及双侧卵巢多发性椭圆形肿物,切面灰白、灰红色,内有大小不等的囊腔,呈海绵状外观,质软,细腻。光镜下见子宫内膜样腺体弥漫散在分布,形状不规则,部分腺体囊性扩张。腺体间见增生的短梭形细胞,似增生期子宫内膜间质细胞。细胞密集,无不典型性,核分裂象少见。病变局部见出血、退变及钙化。局部区域间质纤维化明显,可见呈簇的厚壁血管。免疫表型:间质细胞CD10和vimen-tin均弥漫(+),SMA(-),Ki-67增殖指数<2%,腺上皮细胞CK、上皮及间质细胞ER(+)。结论息肉样子宫内膜异位症是子宫内膜异位症的一种非常罕见的变型,在临床、外科手术及病理诊断中极易被误诊为恶性肿瘤,需与Müllerian腺肉瘤及具有腺样分化的子宫内膜间质肉瘤鉴别。     

子宫内膜样腺癌组织中p53蛋白和VEGF的表达及意义

子宫内膜癌是最常见的女性生殖道恶性肿瘤之一,近年来子宫内膜癌的发病率有明显增高趋势,与宫颈癌收治率比较,已趋接近甚至超过,而与雌激素相关的子宫内膜样腺癌占全部子宫内膜癌的80％～900h,,其与子宫内膜增生过长关系密切。笔者运用免疫组化S-P法检测p53、VEGF在子宫内膜样腺癌中的表达,旨在探讨其与子宫内膜样腺癌的组织学分级、浸润深度、临床分期和肿瘤转移、预后的关系。     

子宫具有中肾形态特征的腺癌4例临床病理分析

目的 探讨子宫具有中肾形态特征的腺癌的临床病理学特征。方法 对2例子宫颈中肾腺癌(mesonephric adenocarcinoma, MA)及2例子宫体子宫内膜中肾样腺癌(mesonephric-like adenocarcinoma, MLA)进行HE、免疫组化染色,并结合相关文献分析其临床病理学特征。结果 4例患者发病年龄47～76岁,平均65岁,以绝经后阴道出血常见。MLA/MA可见弥漫或局部黏液样变伴炎细胞浸润的肿瘤间质背景,组织形态结构多样,表现为单腺管状伴腺腔内嗜酸性分泌物、筛状、乳头状、导管状伴导管内低级别乳头状瘤样生长,少数呈梭形平滑肌瘤样、性索样及鞋钉状透明细胞样。免疫表型：GATA3、DNA错配修复蛋白及SMARA4均阳性,p53野生型,p16阴性或斑驳非钟点状阳性,Napshin A、PR及WT1均阴性;3/4例CR核阳性及CD10腺腔腔缘阳性,Ki-67增殖指数25%～60%。随访3～16个月,均无瘤生存,无复发及转移。结论 MLA/MA在形态学及免疫表型上相似,但来源可能不同,MLA来源与苗勒管更为相近。     

子宫内膜样腺癌组织中PRRX1蛋白的表达及临床意义

目的探讨配对相关同源框1(paired related homoeobox 1,PRRX1)蛋白在子宫内膜样腺癌组织中的表达及临床意义。方法选取安徽医科大学第一附属医院以及安徽医科大学附属巢湖医院267例子宫内膜组织标本,其中正常子宫内膜86例,子宫内膜上皮内瘤变90例,子宫内膜样腺癌91例,均行免疫组化EliVision法检测,观察不同子宫内膜组织中PRRX1表达及子宫内膜样腺癌临床病理特征与PRRX1的关系。结果PRRX1蛋白表达主要定位于子宫内膜样腺癌组织的细胞核中,91例子宫内膜样腺癌组织中PRRX1阳性率为79.1%,高于正常子宫内膜组织(0)、子宫内膜上皮内瘤变组织(10.0%),差异有统计学意义(P<0.05)。子宫内膜样腺癌患者按FIGO分级分类,FIGO1级的PRRX1阳性率低于FIGO 2、3级,差异有统计学意义(P<0.05);按患者年龄、临床分期、有无淋巴结转移分组,PRRX1阳性率差异均无统计学意义(P>0.05)。结论子宫内膜样腺癌组织中的PRRX1表达量高,且与FIGO分级相关。     

子宫颈腺癌与子宫内膜腺癌的组化及免疫组化观察

目的：探讨组化染色及免疫组化在宫颈腺癌与宫内膜腺癌诊断价值及临床意义。方法：采用组化染色及免疫组化Ｓ－Ｐ方法对宫颈腺癌及宫内膜腺癌的粘蛋白含量、分布及免疫组化阳性物的表达进行观察。结果：宫颈腺癌以含丰富的唾液酸粘蛋白为主，而子宫内膜腺癌以硫酸粘蛋白为主。波形蛋白（ｖｉｍｅｎｔｉｎ）在宫内膜腺癌阳性表达率６８．９％，而宫颈腺癌大多呈阴性表达，雌激素受体（ＥＲ）表达在宫内膜腺癌达６０．９％，而宫颈腺癌仅１９．６％，两者均差异有显著性（Ｐ＜０．０５）。而抑癌基因ｐ５３和癌基因ｃ－ｅｒｂＢ－２阳性率与癌肿的分级和预后有关。结果：粘蛋白组化染色及ｖｉｍｅｎｔｉｎ可帮助鉴别诊断宫颈腺癌及宫内膜腺癌，而ＥＲ、ｐ５３、ｃ－ｅｒｂＢ－２对病人的预后有一定意义     

子宫内膜样腺癌中Stathmin和Ki-67的表达及意义

目的:研究Stathmin和Ki-67在子宫内膜样腺癌和正常子宫内膜中的表达差异,探讨Stathmin和Ki-67在子宫内膜样腺癌发生发展过程中的意义.方法:采用免疫组织化学法检测99例子宫内膜样腺癌及67例正常子宫内膜中Stathmin和Ki-67的表达情况.结果:子宫内膜样腺癌中Stathmin和Ki-67表达率分别为75.8%,70.7%,显著高于正常子宫内膜中的9.0%,4.5%,差异有统计学意义(P<0.05);Stathmin和Ki-67表达与子宫内膜样腺癌组织学分级相关(P<0.05),与患者年龄、临床分期、浸润深度、淋巴结转移及脉管侵犯无关(P>0.05);Stathmin表达和Ki-67表达呈正相关(r=0.672,P<0.05).结论:子宫内膜样腺癌中Stathmin和Ki-67高表达可能共同参与子宫内膜样腺癌发生和分化;Stathmin和Ki-67表达呈正相关,提示Stathmin高表达可能与子宫内膜样腺癌高增殖性相关.     

Expression analysis of URI/RMP gene in endometrioid adenocarcinoma by tissue microarray immunohistochemistry

Multiple studies have recently demonstrated the oncogenic property of URI (or RMP, a member of the prefoldin family of molecular chaperones) during progression of hepatocellular carcinoma, ovarian cancer, and possibly prostate cancer. Most recently, we have shown that URI/RMP is up-regulated in cervical cancer, another reproductive system tumor beside ovarian and prostate cancers. To investigate if URI/RMP also plays a role in other reproductive system tumors, especially in endometrioid adenocarcinoma, we analyzed URI/RMP expression in a TMA (tissue microarray) containing tissues from 30 cases of endometrioid adenocarcinoma (which covers tumor tissues from Grade I through Grade III) and adjacent endometrium by immunohistochemistry (IHC) and densitometry analysis using image-pro plus 6.0 software. Our results showed that the mean density of URI/RMP expression in cancerous tissue is slightly higher than that of the adjacent endometrial tissue, though not statistically significant (p>0.05). There is no significant difference either between the mean density of Grade III cancerous tissue and that of Grade I and II cancers. Notably, we detected significantly higher signal intensity in cancerous tissue of all 7 Grade III cases than that of their adjacent endometrial tissue (p<0.05), suggesting a correlation of URI/RMP expression with the differentiation and pathological classification of endometrioid adenocarcinoma. Together, our results demonstrate the heterogeneous expression of URI/RMP in endometrioid adenocarcinoma. The higher level of URI/RMP expression in high-grade endometrioid adenocarcinomas compared to tissues of adjacent endometrium or gland suggests a diagnostic and possibly, a prognostic value of URI/RMP in endometrioid adenocarcinoma.     

子宫颈鳞状移行细胞癌临床病理分析及组织分化观察

目的：探讨子宫颈鳞状一移行细胞癌的临床病理、免疫表型、诊断和鉴别诊断。方法：按2003年WHO宫颈肿瘤分类标准观察5例宫颈鳞状移行细胞癌患者的临床病理特点,应用免疫组织化学方法对宫颈活组织和手术标本进行组织形态和免疫表型的检测。结果：患者年龄中位数为45岁,临床主要表现为阴道异常出血,肉眼子宫颈肥大、呈颗粒状、息肉样或菜花样新生物（4／5）。显微镜下未见明显挖空细胞,呈移行或鳞状细胞样分化,部分似有腺细胞样分化。组织形态学：肿瘤由纤维血管轴心的乳头状结构构成,乳头由多层异型鳞状及移行细胞样上皮覆盖。2例非浸润性,2例乳头间质浸润,1例子宫颈壁浸润;免疫组化显示P16和细胞角蛋（cytokeratin,CK）19和CK5／6均强阳性,CK7阳性强弱不等,1例CK20上皮表层灶状阳性,余为阴性;4例高危型HPV检测阳性。结论：鳞状移行细胞癌是兼有鳞状-移行细胞形态和一定腺样分化的非腺性乳头状鳞状细胞癌,它与高危型HPV感染相关,具有向乳头间质和宫颈壁浸润、复发及转移的特点。鳞状移行细胞癌需与宫颈其他乳头状肿瘤鉴别。     

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.     

Lymphatic invasion according to D2-40 immunostaining is a predictor of nodal metastasis in endometrioid adenocarcinoma of the uterine corpus

In endometrioid adenocarcinoma of the uterine corpus, nodal metastasis is related to prognosis. D2-40 immunostaining has recently been used to detect lymphatic invasion, but a study of D2-40 immunostaining for endometrioid adenocarcinoma of the uterine corpus has not been published. Therefore, as a predictor of nodal metastasis in endometrioid adenocarcinoma of the uterine corpus, the detection of lymphatic invasion on D2-40 immunostaining and lymphovascular invasion on HE stain was compared. A total of 104 cases of invasive endometrioid adenocarcinoma of the uterine corpus, in which the tumor was located in the uterus, were examined on immunohistochemistry using D2-40. In 20 cases there was lymphatic invasion according to D2-40 immunostaining, and the lymphatic invasion was well detected on D2-40 immunostaining. Nodal metastasis was present in 11 cases. Both lymphatic invasion on D2-40 immunostaining and lymphovascular invasion on HE stain were statistically correlated with nodal metastasis, but the evaluation of lymphatic invasion on D2-40 immunostaining was more accurate than detection of lymphovascular invasion using HE stain, in the current and previous studies, for the prediction of nodal metastasis. In conclusion, lymphatic invasion demonstrated on D2-40 immunostaining is very useful as a predictor for nodal metastasis in endometrioid adenocarcinoma of uterine corpus.     

Prognostic value of Musashi-1 in endometrioid adenocarcinoma

Aims: Musashi-1, a RNA-binding protein, is suggested to be a cancer stem cell-related marker; its high level of protein expression is reported to be associated with high histological grade in some tumors. The aim of this study was to investigate the prognostic value of Musashi-1 in patients with endometrioid adenocarcinoma (EAC). Methods: We examined the Musashi-1 mRNA expression level in 35 fresh EAC tissue samples and 15 normal endometrium samples by real-time RT-PCR, and its protein expression level in 148 paraffin EAC tissue samples and 20 paraffin normal endometrium samples by immunohistochemistry. The correlation between Musashi-1 and overall survival (OS) used Cox proportional hazards regression. The prognostic accuracy of Musashi-1 compared with other clinicopathological risk factors by logistic regression. Furthermore, we examined whether Musashi-1 expression is correlated with another cancer stem cell marker CD133 by real-time RT-PCR. Results: Musashi-1 mRNA expression of EAC is 2.8-fold higher than that of normal endometrium (P = 0.0009). Musashi-1 protein expression level is correlated with tumor stage, grade and vascular invasion. Patients with higher protein expression level of Musashi-1 are associated with poor survival rate than those with negative or low level of expression (HR = 2.073, P = 0.001). The area under the curve (AUC) for Musashi-1 is 0.8, which is higher than other clinicopathological factors (P = 0.000). In addition, Musashi-1 mRNA expression seems to be closely correlated with CD133 expression (r = 0.7167, P < 0.0001). Conclusions: Our results suggest high level of Musashi-1 protein expression is associated with poor survival in EAC patients, which may be an independent prognostic factor for EAC.     

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.