摘要
目的 探讨子宫黏液性平滑肌肉瘤（uterine myxoid leiomyosarcoma,UML）的临床病理特征、诊断、鉴别诊断。方法 对6例UML进行HE、免疫组化EnVision法及特殊染色,并复习相关文献及随访。结果 6例患者年龄36~57岁（平均47.33岁）,肿块直径4.5~14cm（平均9.25cm）。低倍镜下肿瘤细胞排列呈片状、束状、簇状或星网状,间质见大量黏液样基质;瘤细胞呈梭形、短梭形、卵圆形。胞质少至中等,胞质嗜酸性,部分肿瘤细胞可见胞质内空泡。核分裂象多少不等（2~20个/10HPF）,可见坏死（3/6）。瘤细胞浸润子宫肌壁平滑肌组织,侵犯脉管,并可见脉管内瘤栓,其中1例细胞具有上皮样特征。免疫表型：肿瘤细胞α-SMA、desmin、h-caldesmon、ER、PR均阳性,CD10、S-100、CD34均阴性,Ki-67增殖指数10%~40%。结论UML属于罕见恶性间叶源性肿瘤,确诊主要依靠形态学及免疫组化标记。临床及病理均需与黏液性平滑肌瘤、黏液性子宫内膜间质肿瘤及黏液性纤维肉瘤等鉴别,治疗以手术切除为主,并辅以化疗,预后较好。
Purpose To investigate the clinicopathologic features, diagnosis and differential diagnosis of uterine myxoid leiomyosareoma （UML）. Method HE staining, immunohistochemistrical staining, and special staining of six cases of UML was performed and followed up, and relevant literatures were also reviewed. Results The six cases, aged from 36 to 57 years old （ median 47.33 ） , measured 4. 5 - 14 cm （average size of 9. 25 cm） in diameter. Histologically, the six cases were similar. In the low magnification, the tumor cells arranged in sheet, fasciculate, tufted or satellite retieulum. Tumor cells were spindle, short spindle, and ovoid. Cytoplasm was mild to medium with eosinophili cytoplasm. Mitotic was varible （generally 2 -20/10 HPF） , and some cases showed necrosis （3/ 6 ）. The tumor cells invaded uterine wall. One case was epithelioid subtype, referring to the epithelioid cell morphology. Immunohistochemistrical profiles： tumor cells were positive for α-SMA, desmin, h-caldesmon, ER and PR. Ki-67 proliferation index were 10% 40%. CD10, S-100, CD34 were all negative. Conclusion UML is an extremely rare malignant mesenchymal tumor, while the diagnosis mainly relies on morphology and immunohistochemistrical staining. Clinically and pathologically, it needs to differentiate diagnosis with uterine myxoid leiomyoma, uterine myxoid endometrial stromal tumor, myxoid fibrosarcoma and so on. The primary treatment for UML is completely surgical excision and chemotherapy. The prognosis is good.
出处
《临床与实验病理学杂志》
CAS
CSCD
北大核心
2016年第5期514-518,共5页
Chinese Journal of Clinical and Experimental Pathology
