子宫内膜间质肿瘤临床病理分析

目的 探讨子宫内膜问质肿瘤的临床、病理及其多成分分化特点、鉴别诊断和预后。方法 分析37例子宫内膜间质肿瘤(其中子宫内膜间质结节6例，低度恶性子宫内膜间质肉瘤22例，高度恶性子宫内膜间质肉瘤7例，子宫内膜间质平滑肌混合瘤2例)的临床、病理、合并症、鉴别诊断及预后。结果 不同类型肿瘤均有部分病例伴多成分分化(16例伴平滑肌分化，14例伴性索样分化，1例伴纤维分化)，其中8例同时伴2种分化成分；37例中有9例伴发子宫平滑肌瘤(其中1例同时伴发腺瘤样瘤，1例伴发高分化子宫内膜腺癌)。结论 不同类型子宫内膜间质肿瘤均可伴发多成分分化及其他类型肿瘤，具备多样性病理形态特征，其中以平滑肌分化及性索样分化最为常见；并发肿瘤以平滑肌瘤最为常见。组织化学及免疫组化染色对诊断及鉴别诊断有帮助；肿瘤预后与多成分分化的数量及类型关系不大；肿瘤有无浸润及瘤细胞异型程度、核分裂象数量是确定本瘤性质的必备条件。

Clinicopathological features of endometrial stromal tumours

Objective To investigate the clinico-pathological features, multi-differentiation,differential diagnosis and prognosis of endometrial stromal tumours. Methods The clinical pathological data (including the histological characteristics, histochemical and immunohistochemical staining features) , complication, differential diagnosis and prognosis of endometrial stromal tumours were analyzed. Results According to WHO Histological Typing of Female Genital Tract Tumours (1994), 37 cases of endometrial stromal tumours were divided into endometrial stromal nodule (7 cases), endometrial stromal sarcoma (low grade) (2 cases), endometrial stromal sarcoma (high grade ) (7 cases) , mixed endometrial stromal and smooth muscle tumours (2 cases) . Various tumours presented multi-differentiation: 16 cases with smooth muscle differentiation, 14 cases with sex-cord differentiation, and 1 case with fibrous differentiation. In 8 cases there were two types of differentiation. Moreover, 9 cases were associated with leiomy-oma, among which there was 1 case associated with adenomatoid tumour, 1 case associated with well differentiation endometrial adenocarcinoma. Conclusions All types of endometrial stromal tumour can display multi-differentiation and associated with other type of tumour. They showed various pathomorphological features. Smooth muscle and sex-cord differentiation are the most common types. Leiomyoma is the most commonly associated tumour. Histochemical and immunohistochemical stains can help diagnosis and differential diagnosis. There is no definite correlation between prognosis and the amount or types of multi-differentiation components . But the invasion degree of atypia and amount of mitotic figure of tumour cells are prerequisite to determine the nature of endometrial stromal tumours.