复发性细胞性子宫平滑肌瘤的临床和病理特征

目的 :探讨复发性细胞性子宫平滑肌瘤的临床和病理特征。方法 :复习 40例细胞性子宫平滑肌瘤的临床病理资料 ,选择复发的 10例进行临床病理特征观察 ,并选用actin、desmin、ER、PR、PCNA、p5 3、c erbB 2和bcl 2 8种抗体采用LSAB法进行免疫组化染色。结果 :复发性细胞性子宫平滑肌瘤随着复发次数的增多 ,瘤组织的异型性显著 ,核分裂象增多 ,出现病理性核分裂象 ,并见黏液变性和肿瘤性凝固性坏死区。复发 3次以上的 4例均为肉瘤变 ,ER和PR检测与肌瘤分化呈正相关 ,PCNA和 p5 3检测则与肌瘤分化呈负相关 ,与复发次数呈正相关。结论 :细胞性子宫平滑肌瘤第 1次复发时应给予重视。出现第 2次复发时 ,治疗必须到位 ,应常规进行ER、PR、PCNA和 p5 3检测 ,以防止肉瘤变的发生

Clinicopathologic features of recurrent cellular uterine leiomyoma

Purpose To inquire into the clinicopathologic features of recurrent cellular uterine leiomyoma. Methods The clinicopathologic data of 40 cases of cellular uterine leiomyoma which were followed up were reviewed. Ten cases which recurred were selected to observe the clinicopathologic features. In immunohistochemistry eight kind of antibodies such as actin, desmin, ER, PR, PCNA, p53, c-erbB-2 and bcl-2 were chosen. Results There were obvious atypia, more mitoses, pathological mitoses, mucoid degeneration and neoplastic coagulation necrosis in recurrent cellular uterine leiomyoma with the more times of recurrence. Four cases of leiomyoma which recurred for more than three times were changed into sarcoma. ER and PR were positive relevant to the differentiation of myoma. PCNA an p53 were negative relevant to the differentiation of myoma and positive relevant to the times of tumor recurrence. Conclusions To pay attention to the first time of recurrence of cellular uterine leiomyoma. When the tumor recurs for the second time, ER, PR, PCNA and p53 should be detected routinely. Enough therapy should be given to prevent the sarcomatous change.