子宫内膜癌19例临床病理分析

目的探讨子宫内膜癌(endometrial carcinoma,EC)的病理组织学类型及组织发生、诊断与鉴别诊断。方法观察19例子宫内膜癌的临床病理特点,并对其免疫表型进行分析。结果患者年龄为37～60岁,平均年龄51.6岁;临床表现为阴道不规则出血、阴道排液。Ⅰ型EC 16例,占84.21%,其中子宫内膜样腺癌15例(Ⅰ级9例、Ⅱ级4例、Ⅲ级2例),黏液腺癌1例;ER(+)、PR(+)、VGFR高表达、Ki-67平均>20%肿瘤细胞(+)、p53(-)。Ⅱ型EC 3例,占15.79%,其中浆液性腺癌2例,病理组织学特点为具有复杂分支的乳头状结构,伴有较宽的纤维血管轴心,乳头由明显复层细胞被覆,细胞具有高度异型性,p53(+)、PR(-)、ER(-)、WT-1(-);子宫内膜癌肉瘤1例,癌成分为高分化子宫内膜样腺癌,肉瘤成分为同源性子宫内膜间质肉瘤,癌成分PCK(+)、肉瘤成分CD10(+)、Vimentin癌和肉瘤成分(+),a-SMA(-)、Desmin(-)、a-ihibin(-)。结论Ⅰ型和Ⅱ型EC具有不同的组织学起源和免疫表型,免疫组织化学鉴别其组织学类型具有重要意义。

Clinicopathologic analysis of 19 cases of uterine endometrial carcinoma

Objective To study the pathohistological type,histogenesis,diagnosis and differential diagnosis of endometrial carcinoma（EC）. Methods Clinicopathologic features and immunophenotype of 19 cases with EC were analyzed. Results The average age of patients was 51.6 years（ range 37 to 60 years）. Patients presented vaginal irregular bleeding and apocenosis of vary degrees. Pathohistological type of 19 eases with EC included type I with 16 cases accounting for 84.21%. Of these, 15 cases were endometrioid adenocarcinoma including 9 eases with grade I ,4 with grade II and 2 with grade III ,and 1 case was mucinous adenocarcinoma. Immunophenotype show tumor cells positive to ER/PR, negative to p53, and tumor cells with high expression of VGFR, and Ki-67 index was more than 〉20%. Type II with 3 cases accounting for 15.79% including 2 cases of serous adenocarcinoma and 1 case of cndometrial carcinosarcoma. Histologically, serous adenocarcinoma was often with complicated branching mamillae accompanying with wider core of fibro-vascular and mamillae coating with obvious stratified cells that showed higher heteromorphism. Immunophenotype show tumor cells positive to p53, negative to ER/PR/WT-1. The components of endometrial carcinosarcoma consist of endometrioid adenocarcinoma with well-differentiated and homological endometrial stromal sarcoma. The immunophenotype of endometrioid ad showed cancer component positive to PCK, sarcoma component positive to CD10, both cancer and sarcoma positive to Vimentin, negative to a-SMA/ Desmin/a-inhibin. Conclusion Endometrial cancer include type I and type II those have different histogenesis and immunopheno- type. Immnnohistochemistry has very important values in identifying the histological types.