子宫内膜上皮内癌临床病理研究

目的：探讨子宫内膜上皮内癌的临床病理特点,并复习文献,回顾其研究进展,提高对子宫乳头状浆液性癌的前驱病变的认识。方法：收集5例子宫内膜上皮内癌,均经手术病理分期并随访3-5年,通过HE切片、光镜观察和免疫组织化学研究,结合临床随访资料进行临床病理分析。免疫组织化学染色所用一抗为：p53、Ki67、ER和PR。结果：5例患者均为绝经后妇女,年龄57-79岁（平均68岁,中位65岁）,临床表现为阴道流血或阴道排液,1例为子宫脱垂,影像学检查发现子宫萎缩伴＂宫腔息肉＂或＂子宫内膜增厚＂。镜下：活检和术中病理会诊的组织学特点与典型的子宫乳头状浆液性癌相同，但无子宫肌层浸润，即癌组织局限于子宫内膜层内，临床病理分期为TIa期。经全面手术病理分期，未发现子宫外扩展。5例免疫组织化学染色均为p53＋＋＋、Ki67＋＋＋、ER-和PR-。随访3—5年均健在，无复发或转移。结论：子宫内膜上皮内癌罕见，若全面的手术病理分期无子宫外扩展者，有较好临床预后。回顾文献，子宫内膜上皮内癌可能属于一种特殊的早期癌，而子宫内膜腺体异型增生可能是其前驱病变。

A clinicopathological research on endometrial intraepithelial carcinoma

Objective：To explore the clinicopatholgical features of endometrial intraepithelial carcinoma（EIC） and review its research advancement,to enhance the recognition of EIC.Methods：Five cases of EIC were collected and follow-up for 3-5 years.All cases were staged completely.HE section and immunostaining were employed,and clinical follow-up data were analyzed for their clinicopatholgical features.Immunomarkers including p53,Ki67,ER and PR were determined.Results：All five cases were post-menopausal women,aged from 57 to 79（mean age 68,median age 65）,presented abnormal bleeding,and imaging showed ＂endometrial polypi＂ or ＂endometrium thickening＂.Microscopely,the histological features of endometrial biopsy and intraoperative pathological consultant were same as typical uterine papillary serous carcinoma（UPSC） without myometrium invasion,carcinoma was limited within the endometrial layer with a clinical-pathological stage TIa.After completely operative-pathological staging,no extra-uterine spread were found.Immunohistochemically,all cases display diffuse strong positive for p53 and Ki-67,and negative for ER and PR.These five patients were all alive without disease,without recurrence and metastasis.Conclusion：EIC is a rare disease in post-menopause women with a good prognosis if no spread beyond unterine after completely operative-pathological staging.Recent studies proposed that EIC was likely a specific early carcinoma,while endometrial glandular dysplasia（EmGD） may be its precursor lesion.