Atypical polypoid adenomyomas of the uterus

We performed a clinicopathological immunohistochemical, ultrastructural, and flow cytometric study on six cases of atypical polypoid adenomyoma of the uterus including one with an adenocarcinoma within it. The tumours occurred in nulliparous women aged 22–48 years (average, 33.0 years); three arose in the uterine corpus, and three in the endocervix. Histologically, they were composed of endometrial glands admixed with a stromal component of interlacing bundles of smooth muscle cells. The glands exhibited varying degrees of architectural and cytological atypia. Most of the stromal cells showed strong staining for HHF35, alpha-smooth muscle actin, and vimentin, and some cells contained desmin. Electronmicroscopy, in one case, confirmed the presence of a well-differentiated smooth muscle component. The stromal component may arise as a result of extensive metaplasia of endometrial stromal cells. Uninvolved endometrium showed ciliated cell metaplasia in three patients, and atypical complex hyperplasia in two. One patient had a well-differentiated adenocarcinoma of endometrioid type arising in an endocervical atypical polypoid adenomyoma. All tumours had a diploid DNA content and relatively small S phase fraction (average, 6.23%). The follow-up periods ranged from 4 to 42 months (average, 13.5 months), and all patients were alive and well. Although the histogenesis of atypical polypoid adenomyoma of the uterus remains uncertain, it is suggested that it may arise because of oestrogen-related factors.     

经阴道彩色多普勒超声对子宫腺肌瘤的诊断价值

目的：探讨经阴道彩色多普勒超声对子宫腺肌瘤的诊断价值。方法：选取许昌中医院2020年1月至2022年1月期间收治的80例子宫腺肌瘤患者为研究对象,对上述患者实施经阴道彩色多普勒超声诊断,获得对应的诊断结果,随后将该结果和术后病理分析结果进行比较,最终得出诊断效果。结果：本研究80例子宫腺肌瘤患者中,经阴道彩色多普勒超声检出75例,漏诊或误诊5例,诊断准确率为93.75%;经阴道彩色多普勒检查诊断为子宫腺肌瘤的75例患者中,按照发病部位划分,有10例(13.33%)子宫腺肌瘤出现在子宫前壁区域,65例(86.67%)出现在子宫后壁部位;按照病情特点划分,有63例(84.00%)为单发子宫腺肌瘤,12例(16.00%)为子宫腺肌瘤合并子宫肌瘤。此外,75例患者中有3例患者并发卵巢内膜异位症。75例患者的子宫动脉血流阻力指数为0.75±0.05、搏动指数为1.37±0.04、舒张期峰值速度为(5.83±0.14)cm·s^-1、收缩期峰值速度为(71.74±0.25)cm·s^-1。结论：经阴道彩色多普勒超声可通过超声特征、血流分布、多普勒频谱特点,准...     

Imaging benign gynaecological conditions

Radiology continues to play an essential role in the management of benign gynaecological conditions. Multiple imaging modalities are utilised to investigate benign conditions: ultrasound; computed tomography and magnetic resonance imaging. Each modality has a different role in diagnosis, treatment selection and follow-up. This review discusses the different imaging modalities and their recommended roles in the imaging benign gynaecological conditions. The imaging findings of common benign female pelvic pathology are discussed and illustrated.     

Imaging benign gynaecological conditions

Radiology plays an essential role in the management of benign gynaecological conditions and includes: ultrasound; computed tomography and magnetic resonance imaging. Each modality has a different role in diagnosis, treatment selection and follow-up. This review discusses the different imaging modalities, their recommended roles in the imaging and imaging findings of common female pelvic pathology.     

电话随访对子宫腺肌瘤术后 GnRH-a治疗效果的影响

目的：观察电话随访护理干预对促性腺激素释放激素激动剂（ GnRH-a）治疗子宫腺肌瘤剔除术患者临床效果的影响。方法选择2009年1月—2011年12月行子宫腺肌瘤剔除术后联合GnRH-a治疗的115例患者,按照随机数字表法随机分成研究组55例和对照组60例。研究组对患者进行电话跟踪随访,给予饮食、休息、活动、生活、精神等方面正向的引导、持续的心理干预、复诊提醒及不良反应的应对措施等护理干预。对照组未进行电话随访护理干预,按常规主管医生门诊定期随访复诊。结果研究组患者痛经症状缓解或消失者53例（96．36％）,术后无明显复发者52例（94．54％）,经量减少经期缩短者52例（94．54％）,对照组依次为49（89．09％）,51（92．72％）,50（90．90％）,两组比较差异无统计学意义（χ2值分别为1．21,0．00,0．13;P＞0．05）。两组患者潮热盗汗、皮疹痤疮、恶心头痛、四肢乏力、关节酸痛、烦躁抑郁等发生率比较,差异有统计学意义（χ2值分别为6．15,6．15,4．45,5．04,4．25,4．25;P＜0．05）。两组患者坚持规律用药、定期复查、改变不良生活习惯与正确应对不良反应的依从性比较差异有统计学意义（χ2值分别为5．49,7．31,14．31,10．45;P＜0．05）。结论电话随访护理干预可提高子宫腺肌瘤剔除术后联合GnRH-a治疗患者的依从性,患者能正确有效应对不良反应,降低不良反应发生率,增进护患关系。     

子宫肌瘤及子宫腺肌瘤的彩色多普勒血流显像及多普勒频谱分析

目的探讨子宫肌瘤及子宫腺肌瘤的彩色多普勒血流分布及多普勒血流频谱特点,以提高超声对子宫肌瘤及子宫腺肌瘤的鉴别诊断符合率。方法对68例子宫肌瘤及33例子宫腺肌瘤进行彩色多普勒超声检测,检测结果与其病理进行对照分析。结果①子宫肌瘤彩色多普勒血流常环绕肿瘤周边,其内部血流常为周边血管分支进入,而子宫腺肌瘤彩色多普勒血流常平行或走向稍紊乱进入瘤体内,与瘤体外正常肌层内血管走行方向基本一致。②子宫肌瘤多普勒血流频谱常表现为肿瘤周边血流峰值速度及血流阻力指数（RI）明显高于肿瘤内部（P〈0.05）;而子宫腺肌瘤周边与其内部血流峰值速度及血流阻力指数（RI）比较常无明显差异（P〉0.05）。结论彩色多普勒血流分布特点及其多普勒血流频谱特征是鉴别子宫肌瘤及子宫腺肌瘤值得重视的指标。     

宫腔镜治疗子宫息肉样腺肌瘤22例临床分析

目的探讨子宫息肉样腺肌瘤的宫腔镜表现和治疗。方法2000年10月～2006年2月我院收治的子宫息肉样腺肌瘤患者22例。其中息肉样腺肌瘤18例，非典型性息肉样腺肌瘤4例。全部患者均接受宫腔镜下子宫内膜息肉切除术（TCRP）治疗，术后随访2～42个月。结果22例患者经超声检查和宫腔镜检查均不能将其与子宫内膜息肉或粘膜下肌瘤区分。绝经前妇女占40．91％（9／22）。绝经后妇女占59．09％（13／22）。患者的平均体重指数（BMI）是（26．5±4．10）。绝经后患者的平均卵巢体积为（1．57±2．49）cm^2；绝经前和绝经后患者子宫内膜厚度分别为（0．94±0．66）cm和（0．71±0．72）cm。1例绝经后息肉样腺肌瘤患者宫腔镜治疗后1年。因阴道出血再次行宫腔镜检查，病理检查显示为非典型性息肉样腺肌瘤，同时合并子宫内膜非典型性增生，行子宫全切术。结论息肉样腺肌瘤是一种特殊类型的子宫内膜息肉，在临床和宫腔镜下没有特异性表现，必须由病理确诊；非典型性腺肌瘤可能发生在息肉样腺肌瘤的基础上。     

Uterus-like mass of the small bowel mesentery

A case of a uterus-like mass arising from the mesentery is reported. A mass measuring 14x11 cm was noted in the small bowel mesentery of a 59-year-old woman. Histologically, the lesion consisted of endometrial-type and fallopian tube-type mucosa surrounded by thick bundles of smooth muscle cells. Since the first report by Cozzutto in 1981, 10 cases of uterus-like mass, that included seven ovarian and three extraovarian cases, have been reported. To our knowledge, the present lesion was the first case originating from the mesenteric region. Three hypotheses of this rare lesion: (i) congenital anomaly; (ii) metaplasia; and (iii) heterotopia theories are reviewed.     

子宫内膜非典型性息肉样腺肌瘤11例临床病理分析

目的 探讨子宫内膜非典型性息肉样腺肌瘤(APA)的临床病理特点,以期提高对其诊断,鉴别诊断和治疗水平.方法 对11例APA进行组织病理学观察,部分辅以免疫表型分析,结合临床资料并复习相关文献.结果 患者平均年龄45岁,其中9例发生于绝经前.临床主要表现为宫腔占位,宫颈内口赘生物和不规则阴道出血.光镜下肿瘤呈纤维肌性间质中出现腺上皮细胞轻度到非常明显非典型性及结构复杂的子宫内膜样腺体.免疫表型:间质细胞SMA弥漫强阳性表达,desmin局灶阳性,CD10局灶阳性;腺上皮及间质细胞ER、PR均强阳性;Ki-67少量散在阳性表达,p53阴性.维多利亚蓝染色:间质胶原纤维红色,弹力纤维蓝色,平滑肌纤维黄色.随访6例患者均预后良好.结论 APA是一种罕见的子宫上皮和间叶混合性肿瘤,病理诊断主要依靠组织病理和免疫组化抗体标记.须与高分化子宫内膜样腺癌、恶性Mtillerian混合瘤、腺纤维瘤和腺肉瘤、子宫内膜息肉等鉴别.病变彻底切除是治疗APA的主要手段.