10例子宫恶性肿瘤合并异位非典型增生子宫内膜病理研究

目的 对子宫恶性肿瘤合并子宫内膜异位病变进行分析,探讨异位内膜非典型增生的临床病理意义。方法 回顾性对188例子宫恶性肿瘤手术病例中合并异位非典型增生子宫内膜的病例进行临床病理分析。所有标本均经常规病理制片程序、HE和免疫组化染色,其中子宫内膜癌的病理分级诊断根据FIGO系统;异位内膜非典型增生的诊断根据Kurman-Norris分类标准。结果 188例子宫恶性肿瘤中合并有12例异位子宫内膜,其中10例异位内膜表现有不同程度的非典型增生(3例重度、2例中度、5例轻度)。其中1例曾因子宫腺肌症被切除子宫,病理随访发现该患者的异位内膜出现轻～重度非典型增生。第2次手术证实阴道断端肿物为子宫内膜间质肉瘤。异位非典型增生内膜的部位:7例发生在卵巢,腺肌症2例、宫颈1例、腹腔淋巴结1例、骶骨韧带1例,其中多部位异位者2例。结论 对子宫内膜异位做病理检查时,关注异位内膜的非典型增生的程度是十分必要。并发有子宫恶性肿瘤的异位内膜,其非典型增生的发生率要明显高于无并发肿瘤者,且重度非典型增生的异位内膜发展为肿瘤危险性高。

The clinicopathological signfflcance of atypical hyperplasia of ectopic endometrium in 10 cases of uterine malignant tumor with endometriosis

Objective To study the clinicopathological significance of atypical hypeiplasia in uterine malignancies coexisting with endometriosis. Methods 12 cases of uterine malignant tumors coexisting with endometriosis from 188 cases of uterine malignancies in the same time . All the specimens were treated with routine pathological procedure, H-E and immunohistoche-mical stainings. FIGO system was used for the diagnosis of endometrial carcinoma; and Kurman - Norris criteria for the atypical hyperplasia of ectopic endometrium. Results 10 cases of atypical hypeiplasia of 12 ectopic endometrium from 188 could be identified to varying degrees , which was uterine malignancies much higher than the records of the literatures. There were 3 cases of severe atypical hyperplasia, 2 moderate, and 5 mild. Hysterectomy was performed for endometriosis in one case. Pathological follow - up revealed that atypical hyperplasia developed on her ectopic endometrium, and progressed from moderate into severe. The second operation had proved that the mass at the vaginal apex was endometrial stroma sarcoma. Conclusions The incidence of atypical hyperplasia on endometriosis coexisting with uterine malignant tumors was much higher than those without uterine malignancies. The risk of cancer was higher in endometriosis with severe atypical hyperplasia, so more attention should be paid to the atypical hyperplasia of endometriosis.