子宫非典型性息肉状腺肌瘤10例临床病理分析

目的 探讨子宫非典型性息肉状腺肌瘤的临床病理特征。方法 复习10例子宫非典型性息肉状腺肌瘤的临床资料,观察病理学特征,同时行免疫组织化学染色。结果 患者年龄31～53岁（平均41.1岁）,除2例外,均为生育期妇女。4例为不孕症患者。肿瘤4例位于子宫下段,1例位于宫颈口,4例位于宫体部,1例位置不详。7例行息肉切除或刮宫术,3例行子宫切除术。组织学上,不规则腺体呈息肉状增生,细胞具有非典型性,间质可见平滑肌和纤维母细胞增生。其中7例伴有鳞状上皮化生。免疫组织化学染色：所有病例间质均显示SMA和Desmin（＋）,腺体显示ER和PR（＋）,p53（-）,Ki-67增生指数10%～20%。随访9例,随访时间3～92个月（平均41.3个月）,其中1例行息肉切除术患者在初次诊断后15个月复发,行二次息肉切除术,术后17个月患者情况良好,无复发。其余8例无复发表现,体健。结论 子宫非典型性息肉状腺肌瘤具有特征性组织结构：即在平滑肌纤维间质中出现具有细胞学异型性的复杂增生的腺体,因而最需与子宫内膜样腺癌相鉴别。典型的病例临床过程良好,部分病例具有低度恶性潜能,病变可复发。

Atypical polypoid adenomyoma of the uterus: a clinicopathologic study of 10 cases

Objective To explore the clinicopathological features of the atypical polypoid adenomyoma (APA) of the uterus.Methods Clinical data and HE slides were reviewed and immunohistochemical stains were performed in 10 cases of APA,with follow-up in 9 cases.Results Patients were 31 to 52 years old (mean at 41.1). All but two of the patients were premenopausal,and 4 with infertility. Except that one was unclear of its location,four arose at low segment of uterus,one in cervical canal,and four at the uterine fundus. Histologically,the lesions featured a polypoid proliferation of irregular,atypical endometrial glands,with a smooth-muscle and fibroblastic stroma. Squamous metaplasia was found in seven cases. Seven patients underwent polypectomy or curettage and three hysterectomy. Nine patients were followed up for 3 to 92 months after diagnosis (mean for 41.3 months). One patient with initial polypectomy recurred at 15 months and was free of disease for another 17 months after secondary polypectomy. All the other patients did not show any sign of recurrence.Conclusions Atypical polypoid adenomyofibromas have histological features of proliferation of architecturally complex and cytological atypical glands within a myofibromatous stroma,which should make differential diagnosis from endometrioid carcinoma. Most APA is typically indolent,with a few present low malignant potential of recurrence.