11例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的临床病理学特征治疗与预后.方法:11例低度恶性子宫内膜间质肉瘤中9例行子宫、双附件及盆腔淋巴结切除,2例行子宫及一侧附件切除,11例患者经随访2～8年均健在.结果:病理特点为子宫均匀增大,肿物多位于子宫后壁近宫底处,切面实性呈灰白或灰黄色,质地糟脆,有时见微小囊腔.镜下:瘤细胞似增殖期子宫内膜间质细胞,螺旋小血管多见,瘤细胞呈舌状侵及肌层或有多个浸润灶,与周围平滑肌束无移行,肿瘤组织中缺乏腺体成分.11例中1例伴上皮样性索分化,1例伴平滑肌分化.免疫组化:肿瘤细胞对Vimentin、SMA、Desmin、KP-1、ER、PR均有表达.结论:低度恶性子宫内膜间质肉瘤具有多样性病理特征,免疫组化对诊断及鉴别诊断有帮助,术前诊刮及术中冰冻可提高诊断率.全子宫、双附件切除及盆腔淋巴结清扫结合术后放疗和孕激素治疗可以减少复发,本病预后较好.

A Clinical-pathology Analysis on 11 Cases with the Low-grade Malignant ESS

Objective:To inve st igate the clinical pathological characters,therapy and prognosis of the low)gr ade malignant endometrial stromal sarcoma(ESS).Methods:Among the11cases of the low)grade malignant endometrial stromal sarcoma,9cases were excised uter us,double sides accessories and pelvic cavity lymph node,2cases were excised uterus and one side accessory.During2)8years's follow)up,11patients were still well.Results:Pathological characters:Uterus increases equably.Most tu mors are located at the fundus of uterus's posterior wall.The sectioned surface of the tumors is hoariness or lark,and its texture is crisp,and sometimes the tiny bursal cavities are seen.On the microscopic examination:The tumor cells look like the endometrial stromal cell of proliferation phase,and the helical v eins are often found.The tumor cells present ligulate)invasion reaching the mu scular layer or many infiltrating foci,But there is no transmigration with the surrounding smooth muscle bundles.The tumor tissue is lack of gland component. One case of the11cases is companied with epithelioid sexual cord differentiati on,and one case is companied with smooth muscle differentiation.Immunohistoche mistry:The knubbly cells have expression to Vimentin?SMA?Desmin?KP)1?ER? PR.Conclusion:The low)degree malignant ESS has a diversity of pathological ch aracters.The immunohistochemistry redounds to diagnosis and differential diagno sis.The pre)operation diagnostic curettages and mid)operation frozen section can improve the rate of diagnosis.Excising the whole uterus and double side acc essories can reduce the relapse.The prognosis of this disease is better.