低度恶性子宫内膜间质肉瘤临床病理分析

目的:探讨低度恶性子宫内膜间质肉瘤(LESS)的临床病理学特征、诊断和鉴别诊断。方法:收集17例低度恶性子宫内膜间质肉瘤,复阅病历档案,进行随访,同时观察其临床病理特点,并作免疫组化染色分析。结果:患者年龄24~73岁,平均44.5岁。低度恶性子宫内膜间质肉瘤(LESS)临床上主要表现为不规则的阴道出血。光镜下观察肿瘤细胞类似增殖期子宫内膜间质细胞;呈舌状浸润肌层或弥漫浸润,肿瘤内有大量的似螺旋小动脉。3例伴有不同程度的平滑肌分化,1例伴性索样分化。结论:低度恶性子宫内膜间质肉瘤(LESS)临床少见,术前诊断困难,预后较好。确诊主要依靠组织病理学和免疫组化,诊断上应与富细胞性平滑肌瘤、静脉内平滑肌瘤病、腺肉瘤相鉴别。

Low-grade Endometrial Sarcoma:A Clinicopathologic Analysis

Objective: To investigate the clinical features and differential diagnosis of low-grade endometrial stromal sarcoma.Methods:Seveteen cases of LESS were analyzed by means of reviewing the history records,observing on both HE and immunohistoche staining.The clinicopathological features of the LESS were studied and these cases were followed-up.Results: The patients were from 24 to 72 years in age(mean age 43 years).The main clinical symptom of these patients was irregular vaginal bleeding.Microscopically,the tumor cell resembled the endometrial stromal cell of proliferation phase and helical arterioles were often found.The tumor cell presented ligulate-invasion reaching the muscular layer or diffusely infiltrating pattern.There were a lot of blood vessels in the tumors.Three tumors showed variable degrees of smooth muscle differentiation and sex cord-like differentiation occurred in one.Conclusion: LESS is an uncommon tumor in clinic.It is difficult to diagnose pre-operation and prognosis of LESS is usually better.The diagnosis relies mainly on histopthological and immunohistochemical findings.It should be distinguished from leiomyoma with abundant cells,intravenous leiomatosis and Millerian adenosarcoma.