子宫内膜间质肉瘤55例临床病理特点和预后分析

目的 了解子宫内膜间质肉瘤(ESS)的病理形态特征并分析影响预后的相关指标.方法 收集该院55例ESS患者的临床和病理资料,所有病例重新阅片,参照文献分类为低级别子宫内膜间质肉瘤(LGESS)、不伴核多形的未分化子宫内膜肉瘤(UES-U)、伴有核多形的未分化子宫内膜肉瘤(UES-P);同时观察肿瘤细胞的形态特点,包括纤维样、肌样、黏液样、上皮样分化,并计数核分裂象等.对所有病例进行临床资料的收集并随访.结果 LGESS、UES-U、UES-P型病例分别为39、9、7例.病理形态上,ESS有多种形态分化并存的特点,LGESS、UES-U及UES-P型病例中分别有12.8%(5/39)、5/9及5/7伴有两种以上混合的形态学分化;同一病例的不同区域核分裂象计数和组织学类型亦存在较大差异.临床上肿瘤复发比例分别为51.6%(16/31)、5/6、2/3;LGESS无死亡病例,UES-U和UES-P中各有2例死亡,且UES-U的死亡病例均有局灶UES-P区域.按核分裂象最高计数进行预后分析,≥10/10 HPF的病例复发率显著高于＜10/10 HPF的复发率(P=0.009),在LGESS病例中亦存在这种统计学差异,所有死亡病例的核分裂象最高计数均＞30/10 HPF.结论 ESS常见不同程度分化重叠及多向分化的特点,尤以UES-U和UES-P中更为常见,因此应充分取材以寻找诊断线索.肿瘤中伴有UES-P图像,同时伴核分裂象计数高度活跃可能会增加死亡风险.在LGESS病例中,核分裂象最高计数≥10/10 HPF的肿瘤复发率显著增高,在诊断时应引起重视.

Abstract：

Objective To investigate the clinicopathologic features and the prognostic factors of endometrial stromal sarcoma (ESS). Methods 55 cases of endometrial stromal sarcoma were reviewed and categorized into 3 pathologic types based on the related literatures, i.e. , low grade endometrial stromal sarcoma (LGESS), undifferentiated endometrial sarcoma with nuclear uniformity (UES-U) and undifferentiated endometrial sarcoma with nuclear pleomorphism (UES-P). Meanwhile, the pathologic features were reviewed, including fibroid, myoid, mucoid, and epithelioid differentiation and mitotic index.Clinical and follow-up data were collected. Results In endometrial stromal sarcoma, two or three pathologic types co-existed in one case, including 12. 8% (5/39) of LGESS, 5/9 of UES-U, and 5/7 of UES-P.Mitotic index varied in different regions of one tumor from rare to high. Multi-differentiation was also commonly seen in ESS. The numbers of cases in LGESS, UES-U and UES-P were 39, 9 and 7, with recurrence rate of 51.6% ( 16/31 ), 5/6 and 2/3, respectively. There was no death case in LGESS, and 2 cases were died in UES-U and UES-P, respectively. In the 2 death cases of UES-U, both had focus of UES-P. There was a significant difference in the recurrence rate between cases with different mitotic index ( ≥ 10/10 HPF and ＜ 10/10 HPF, P = 0. 009), especially in LGESS group. All death cases had high mitotic index ( ＞ 30/10 HPF). Conclusions It is a common phenomenon in ESS that two or three pathologic types may exist in one case, especially in UES-U and UES-P. And multi-differentiation is also commonly seen in ESS. So adequate pathologic sampling is important for pathologists to make a correct diagnosis of ESS in daily work. The recurrence rates are significantly higher in cases with high mitotic index,especially in LGESS. In addition, the presence of UES-P and high mitotic index may increase the risk of death in the patients.

Clinicopathologic features and prognostic factors of endometrial stromal sarcoma: a study of 55 cases

Objective To investigate the clinicopathologic features and the prognostic factors of endometrial stromal sarcoma (ESS). Methods 55 cases of endometrial stromal sarcoma were reviewed and categorized into 3 pathologic types based on the related literatures, i.e. , low grade endometrial stromal sarcoma (LGESS), undifferentiated endometrial sarcoma with nuclear uniformity (UES-U) and undifferentiated endometrial sarcoma with nuclear pleomorphism (UES-P). Meanwhile, the pathologic features were reviewed, including fibroid, myoid, mucoid, and epithelioid differentiation and mitotic index.Clinical and follow-up data were collected. Results In endometrial stromal sarcoma, two or three pathologic types co-existed in one case, including 12. 8% (5/39) of LGESS, 5/9 of UES-U, and 5/7 of UES-P.Mitotic index varied in different regions of one tumor from rare to high. Multi-differentiation was also commonly seen in ESS. The numbers of cases in LGESS, UES-U and UES-P were 39, 9 and 7, with recurrence rate of 51.6% ( 16/31 ), 5/6 and 2/3, respectively. There was no death case in LGESS, and 2 cases were died in UES-U and UES-P, respectively. In the 2 death cases of UES-U, both had focus of UES-P. There was a significant difference in the recurrence rate between cases with different mitotic index ( ≥ 10/10 HPF and ＜ 10/10 HPF, P = 0. 009), especially in LGESS group. All death cases had high mitotic index ( ＞ 30/10 HPF). Conclusions It is a common phenomenon in ESS that two or three pathologic types may exist in one case, especially in UES-U and UES-P. And multi-differentiation is also commonly seen in ESS. So adequate pathologic sampling is important for pathologists to make a correct diagnosis of ESS in daily work. The recurrence rates are significantly higher in cases with high mitotic index,especially in LGESS. In addition, the presence of UES-P and high mitotic index may increase the risk of death in the patients.