子宫内膜间质肉瘤有关预后临床病理分析.docVIP

子宫内膜间质肉瘤有关预后临床病理分析 　　摘 要 目的：进一步探讨低度恶性子宫内膜间质肉瘤临床病理特征与复发、转移的关系。方法：对20例低度恶性子宫内膜间质肉瘤（LGESS）分别从患者的年龄,肿物体积，浸润子宫肌层深度及浸润血管状况，核分裂计数并做免疫组化：SMA、Desmin、CD10、ER、PR、Ki-67、P53。结果：年龄35～53岁，平均42岁,肿物体积1.8～9.5cm3/sup，平均4.5cm3/sup。肿物与子宫肌壁界不清，树叶样生长方式，切面灰黄质软，瘤细胞一致类似于正常增生期子宫内膜间质，肿瘤血管独特，由类似于正常子宫内膜的螺旋动脉和薄壁血管腔构成，细胞异型性小，核分裂少，免疫组化SMA（-）、Desmin（-）、CD10（+）、ER（+）、PR（+）、Ki-67（+＜15%）、P53（-～+）。随访20例：其中2年内复发者1例，3～4年复发者1例，5～8年复发者3例，8-10年复发者2例，1年半复发又隔3年死亡1例，其余12例10年未见复发转移。结论肿物体积＜3.5cm3/sup，浸润子宫肌壁较浅者未见复发转移，肿物体积＞3.5cm3/sup，浸润子宫肌壁较深尤其有淋巴管，血管浸润者易复发、转移，未切除全子宫及双附件者易复发、转移,提示此类肿瘤应作全子宫及双附件切除。 　　关键词 低度恶性子宫 内膜间质肉瘤 复发 转移 　　 　　AbstractObjective:To further investigate the relationship between clinical pathological characteristics of low-grade m alignant endometrial stromal sarcomas and recurrence and metastasis.Methods:A retrospective analysis was performed on 20 patients with histologically verified low-grade endometrial stromal sarcomas（LGESS）,analyzing the cases from age、volume of tumor、depth of myometrial invasion、vascular invasion status and Mitotic count,respectively,and employing Immunohistochemical analysis to analyze SMA、Desmin、CD10、ER、PR、Ki-67、P53.Results:Ages at diagnosis were 35～53 years,the mean age was 42 years,tumor sizes were 1.8～9.5cm3/sup,the mean size was 4.5cm3/sup.It is unclear boundary between tumor and uterine muscular layer,leaf-like growth pattern.The sectioned surface of the tumors was sallow and its texture is crisp.Tumer cells weresimilar to the endometrial stromal cell of proliferation phase.Tumor angiogenesis was similar to the spiral arteries of normal endometrium.Cell atypia and Mitotic were rare.Immunohistochemistry:SMA（-）、Desmin（-）、CD10（+）、ER（+）、PR（+）、Ki-67（＜15%）、P53（-～+）.Follow-up:1 case recurred within 2 years.1 case recurred during 3-4years.3 cases recurred during 5-8years.2 cases of recurrence occurred during 8-10years.Among of 20 cases,1 case recurred after one year and a half and then died after 3 years.There were 12 cases had no recurrence and metastasis within 10 years.