摘要
目的探讨子宫黏液样平滑肌肉瘤(MLMS)的临床病理特征、诊断与鉴别诊断、治疗及预后。方法分析3例子宫MLMS的临床资料,观察组织学形态、免疫表型及特殊染色结果,讨论诊断与鉴别诊断并复习相关文献。结果 3例患者中位年龄52. 5岁,肿瘤最大径6~17 cm,无包膜,切面灰白、实性、胶冻状、质软。镜下肿瘤细胞排列稀疏,呈束状、星网状或微囊状及黏液纤维肉瘤样,间质内见大量黏液样基质。肿瘤细胞呈梭形,轻~中度异型,胞质嗜酸性,核呈梭形或短梭形,核分裂象2. 2~5. 4个/2 mm2。其中2例可见凝固性坏死,1例可见细胞内黏液样物质。免疫组化结果:3例SMA和h-caldesmon(+),2例desmin、ER、p16、p53(+),1例PR(+),Ki-67阳性指数为15%~40%;CK-Pan、EMA、CD10、CD34、S-100均(-)。结论 MLMS是一种罕见的平滑肌肉瘤亚型,病理诊断主要依靠组织学特征、免疫表型及特殊染色。手术完整切除肿瘤,术后辅以化疗,可降低肿瘤复发风险,提高生存率。
Objective To explore the clinicopathologic characteristics,diagnosis and differential diagnosis,therapy and prognosis of myxoid leiomyosarcoma of the uterus. Methods Clinical data of 3 cases of myxoid leiomyosarcoma of the uterus were analyzed. Histopathologic features,immunophenotyping and histochemical staining were observed. Diagnosis and differential diagnosis were discussed and related literatures were reviewed. Results The median age of the 3 patients was 52. 5 years old. Tumor sizes were variant from 6 cm to 17 cm. These masses had no capsules and showed a grayish-white cross section. The tumors had a solid mucous and gelatinous appearance. Microscopically,the tumor cells were arranged in a discrete pattern which was presented as fasciculation,reticulation,microcyst and myxofibrosarcoma-like forms. There were plenty of gelatinous substance in the tumor stroma. The spindle tumor cells presented mild to moderate atypia and eosinophilic cytoplasm. The nucleus was spindle or short spindle and the mitosis was 2. 2 ~ 5. 4/2 mm2. There was coagulation necrosis in two of the three cases and one of the three cases had gelatinous substance in the tumor cells.Immunohistochemchal staining showed that the tumor cells were positive for SMA and h-caldesmon( 3/3),desmin,ER,p16,p53( 2/3) and PR( 1/3),but negative for CK-Pan,EMA,CD10,CD34 and S-100. The proliferation index of Ki-67 were variant from 15% ~ 40%. Conclusion MLMS is a rare subtype of leiomyosarcoma. The pathological diagnosis is depended on clinicopathologic characteristics,immunophenotype and histochemical staining. Redical excision of the tumor and postoperative chemotherapy could reduce the recurrent risk and improve the survival rate.
作者
唐云
张雨涛
李小红
李峰
TANG Yun;ZHANG Yu-tao;LI Xiao-hong;LI Feng(Department of Pathology,Zigong First People’s Hospital,Zigong Sichuan 643000,China)
出处
《诊断病理学杂志》
2020年第3期158-161,166,共5页
Chinese Journal of Diagnostic Pathology
关键词
子宫
黏液样平滑肌肉瘤
免疫组化
鉴别诊断
Uterus
Myxoid leiomyosarcoma
Immunohistochemistry
Differential diagnosis
