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目的探讨子宫高度富于细胞性平滑肌瘤的临床病理特征、免疫组化特点、诊断及鉴别诊断。方法回顾性复习14例子宫高度富于细胞性平滑肌瘤的临床表现、组织学形态、免疫组化及冷冻诊断。对照组为10例低级别子宫内膜间质肉瘤。结果患者年龄27～65岁,平均年龄44.6岁;11例有月经改变史。镜下见高度致密的富于细胞性平滑肌瘤的瘤细胞,丰富程度类似于子宫内膜间质肿瘤;细胞呈圆形、卵圆形,胞质少;所有病例均可见大的厚壁血管,其中3例见明显的胶原化间质。免疫组化:11例h-caldesmon(+)、desmin(11/14)和SMA(9/14)不同程度(+),3例CD10局灶(+)。低级别子宫内膜间质肉瘤镜下形态与高度富于细胞性平滑肌瘤非常相似,但免疫组化h-caldesmon(-),CD10(10/10)、desmin(9/10)和SMA(6/10)(+)。结论子宫高度富于细胞性平滑肌瘤与低级别子宫内膜间质肉瘤的鉴别非常困难,尤其在冷冻切片诊断中;免疫组化染色有助于鉴别诊断。
Objective To investigate the clinicopathological features, immunohistochemical features, diagnosis and differential diagnosis of uterine highly cellular leiomyoma. Methods Retrospective review of 14 cases of uterine highly cellular leiomyoma clinical manifestations, histological morphology, immunohistochemistry and frozen diagnosis. The control group was 10 cases of low-grade endometrial stromal sarcoma. Results The patients were 27-65 years of age with a mean age of 44.6 years and 11 had history of menstruation. Microscopically, we found tumor cells of highly dense cell-rich leiomyomas rich in a similar degree to those of endometrial stromal tumors. The cells were round, ovoid and cytoplasm less. All the cases showed large thick-walled vessels , Of which 3 cases showed obvious collagen interstitial. Immunohistochemistry: There were 11 cases of h-caldesmon (+), desmin (11/14) and SMA (9/14) in varying degrees (+) and 3 cases of CD10 focal (+). The morphology of the low grade endometrial stromal sarcoma is very similar to that of the highly cellular leiomyoma, but immunohistochemistry h-caldesmon (-), CD10 (10/10), desmin (9/10) and SMA 6/10) (+). Conclusion It is very difficult to differentiate uterine highly cellular leiomyoma from low-grade endometrial stromal sarcoma, especially in frozen section diagnosis. Immunohistochemical staining is helpful to differential diagnosis.