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目的:探讨低度恶性子宫内膜间质肉瘤的临床病理学特征治疗与预后。方法:11例低度恶性子宫内膜间质肉瘤中9例行子宫、双附件及盆腔淋巴结切除,2例行子宫及一侧附件切除,11例患者经随访2～8年均健在。结果:病理特点为子宫均匀增大,肿物多位于子宫后壁近宫底处,切面实性呈灰白或灰黄色,质地糟脆,有时见微小囊腔。镜下:瘤细胞似增殖期子宫内膜间质细胞,螺旋小血管多见,瘤细胞呈舌状侵及肌层或有多个浸润灶,与周围平滑肌束无移行,肿瘤组织中缺乏腺体成分。11例中1例伴上皮样性索分化,1例伴平滑肌分化。免疫组化:肿瘤细胞对Vimentin、SMA、Desmin、KP-1、ER、PR均有表达。结论:低度恶性子宫内膜间质肉瘤具有多样性病理特征,免疫组化对诊断及鉴别诊断有帮助,术前诊刮及术中冰冻可提高诊断率。全子宫、双附件切除及盆腔淋巴结清扫结合术后放疗和孕激素治疗可以减少复发,本病预后较好。
Objective: To investigate the clinicopathological features and prognosis of low grade endometrial stromal sarcoma. Methods: Nine cases of 11 cases of low grade endometrial stromal sarcoma were removed by uterus, double attachment and pelvic lymphadenectomy, 2 cases were removed by uterus and one side attachment, 11 cases were followed up for 2-8 years. Results: Pathological features of the uterus increased evenly, the tumor located in the uterine wall near the bottom of the palace, the cut was gray or gray solid, crisp texture, and sometimes see the tiny cysts. Microscope: tumor-like proliferative endometrial stromal cells, spiral small blood vessels more common, tumor cells were tongue-invasive muscle or multiple infiltration foci, and peripheral smooth muscle bundles without migration, tumor tissue lack of glands ingredient. In 11 cases, 1 case had epithelioid cord differentiation and 1 case had smooth muscle differentiation. Immunohistochemistry: The tumor cells expressed Vimentin, SMA, Desmin, KP-1, ER and PR. Conclusions: Low grade malignant endometrial stromal sarcoma has various pathological features. Immunohistochemistry may be helpful in the diagnosis and differential diagnosis. Preoperative curettage and intraoperative freezing can increase the diagnostic rate. Full uterus, double attachment resection and pelvic lymph node dissection combined with postoperative radiotherapy and progesterone treatment can reduce recurrence, the prognosis of this disease is better.