高分化子宫内膜样腺癌与子宫内膜非典型增生的临床病理观察与鉴别诊断

目的：探讨高分化子宫内膜样腺癌（简称腺癌）与子宫内膜非典型增生（简称增生）的临床病理学特征及鉴别诊断。方法：对56例腺癌及56例增生病例进行临床病理分析。结果：腺癌与增生均见细胞异型性，有核分裂，不同的是腺癌组腺体管状或细乳头状，腺体大小不一，排列无极性；腺体密集而拥挤，腺体间无内膜间质，背靠背、共壁、搭桥，尤其是筛状结构；腺腔不规则，不完整，尤其可出现腺上皮增生堆积成角或锥形；另见子宫内膜间质纤维组织增生，腺腔内出现中性白细胞和细胞坏死物。增生组腺体呈管状形成低乳头状，腺体较密集增多，但排列有极性，腺体之间有少量内膜间质，无问质反应．结论：腺癌与增生的鉴别诊断要点是：腺癌腺体密集，排列紊乱，形态不规则，可共壁、搭桥、尤其是筛状结构。诊断间质浸润较困难时，可观察腺体成角或成锥形伸入间质而辨认。其次，腺癌有明显间质反应，即成纤维细胞增生，网状纤维和胶原纤维增多，淋巴细胞浸润及腺腔内出现中性粒细胞及腺上皮坏死碎片。

Differential Diagnosis of Well-Differentiated Endometrioid Adenocarcinoma and Endometrial Alypical Hyperplasia

Objective:To investigate how to distinguish and diagnose the clinical pathological characteristics of the well-differentiated endometriosis adenocarcinoma(adenocarcinoma for short) and the endometrial atypical hyperplasia(hyperplasia for short).Methods: The clinical and pathological analysis of 56 samples of adenocarcinma and another 56 of hyperplasia was made.Results: Both adenocarcinma and hyperplasia were found to have cell atypia and karyokinesis.The difference was for adenocarcinma,glands were in the shape of tube or fine nipples,and the sizes not the same and the arrangement was nonpolarity;glands were dense and crowded,with no intima mesenchyma between each other,and the structure was back on back,sharing the wall,bridging and specially sievelike;the glandular cavity was irregular,not complete and could be glandular epithelium typerplasia particularly,piling up the shape of angle or prick;besides,fibering hyperplasia was found in matrix intima mesenchma and neutrophil and cell spyacelus in glandular cavity.For hyperplasia tube shaped glands form like low nipples.Glands were relatively more densely but the arrangement was polarity,with little intima mesenchma and no mesenchma reactions.Conclusion:The point to distinguish and diagnose adenocarcinoma and hyperplasia are the followings: for adenocarcinoma,glands are dense and crowded,arranged in disorder and the structure is back on back,sharing the wall,bridging and specially sievelike.When it is difficult to diagnose interstitial soakage,it can be recognized by observing that the glands are stretching into the mesenchma in the form of angle or prick.Secondly,adenocarcinoma has parent mesenchma reactions,that is fibrocyte hyperplasia,reticulin and collagen fiber increase,lymphocyte soak and neutrophilic granulocyte and glandular epithelium sphacelus appear in the glandular cavity.