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目的:探讨子宫非典型性息肉样腺肌瘤(atypical polypoid adenomyoma,APA)的临床病理特征。方法:收集3例子宫非典型性息肉样腺肌瘤,分析其临床资料、病理形态学特征、免疫组化标记特点及随访资料。结果:患者2例为绝经前女性,1例60岁。肿瘤2例位于子宫体,1例位于宫体下段。2例行息肉切除术,1例行子宫切除术。组织学表现为腺上皮呈不同程度增生,并伴有一定异型性,3例均出现鳞状上皮化生灶;肿瘤间质主要为增生的平滑肌组织。免疫组织化学染色:所有病例间质细胞均显示SMA和Desmin阳性,腺体显示ER和PR阳性。随访10～54个月,患者均无瘤健在。结论:子宫非典型性息肉样腺肌瘤具有特征性组织结构:平滑肌纤维间质中出现具有细胞学异型性的复杂增生的腺体,需与子宫内膜样腺癌相鉴别。典型的病例临床过程良好,部分病例具有低度恶性潜能,病变可复发。
Objective: To investigate the clinicopathological features of atypical polypoid adenomyoma (APA). Methods: Three cases of uterine atypical polyp adenomatous myoma were collected and analyzed for clinical data, pathomorphological features, immunohistochemical characteristics and follow-up data. Results: Two patients were premenopausal women and one was 60 years old. Tumor in 2 cases located in the uterus, 1 case located in the lower body of the Palace. 2 routine polypectomy, 1 routine hysterectomy. Histological findings showed that the glandular epithelium were proliferated to some extent with a certain atypia. Three cases had squamous metaplasia; the main tumor stroma was hyperplastic smooth muscle tissue. Immunohistochemical staining: All cases of stromal cells showed SMA and Desmin positive, glands showed ER and PR positive. All cases were followed up for 10 ~ 54 months. Conclusion: Uterine atypical polyp adenomatous myoma has the characteristic histological structure: complex hyperplasia of glandular cells in the interstitial of smooth muscle fibers, which need to differentiate from endometrial adenocarcinoma. The typical clinical course of the case is good, some cases have low malignant potential, the disease can relapse.