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目的探讨息肉样子宫内膜异位症的临床病理学特征、诊断与鉴别诊断。方法应用光镜观察及免疫组化染色对3例少见的息肉样子宫内膜异位症进行临床病理学分析。结果 2例患者年龄均为48岁,1例为41岁。3例均表现为宫旁肿物,其中例1与子宫右后壁相连,呈结节状;例2、3均有子宫内膜异位症病史且多次复发。例2起初为双侧卵巢及盆腔肿物,现为子宫浆膜面多囊性肿物;例3初始为子宫下段浆膜面肿物,现为盆腔、阴道断端及髂窝肿物。镜下3例病灶中均可见子宫内膜样腺体及间质成分,其中例1形态学类似子宫内膜息肉,呈单纯性或复杂性增生,部分腺体伴非典型增生,局灶间质细胞有异型性;例2、3部分区域腺腔被覆宫颈型或肠型黏液上皮,部分腺体增生较活跃,呈交界性表现。例1和3术后未治疗,例2术后化疗2周期。目前3例分别随访7、3、28个月,一般状况良好。结论息肉样子宫内膜异位症少见,常发生于绝经后女性,其临床和病理表现均不同于普通型子宫内膜异位症,易被误诊为恶性肿瘤。性激素可能在其发病机制中起作用,预后良好。
Objective To investigate the clinicopathological features, diagnosis and differential diagnosis of polypoid endometriosis. Methods Three cases of polypoid endometriosis were analyzed clinically and pathologically by light microscopy and immunohistochemistry. Results Both patients were 48 years old and 1 case was 41 years old. 3 cases showed parametrial mass, of which case 1 is connected with the right posterior wall of the uterus, nodular; cases 2 and 3 have a history of endometriosis and multiple recurrence. Example 2 initially bilateral ovarian and pelvic masses, is now a polycystic tumor of the uterine serosa; Example 3 initial for the lower part of the uterine serosal surface tumor, now the pelvic, vaginal and iliac crest tumor. Endoscopic glandular and interstitial components of endometrial glandular and interstitial components were found in all of the three lesions. Among them, the morphology of endometrial polyps in Example 1 was simple or complex, with some glands with atypical hyperplasia and focal interstitial Cells have atypia; cases 2, 3 parts of the glands covered cervical or intestinal mucosal epithelium, part of the gland hyperplasia more active, showed a borderline performance. Cases 1 and 3 were not treated postoperatively, and 2 cases were treated with 2 cycles of postoperative chemotherapy. Currently 3 cases were followed up for 7,3,28 months, the general condition is good. Conclusions Polyps-like endometriosis is rare and often occurs in postmenopausal women. The clinical and pathological findings are different from those of common endometriosis and are easily misdiagnosed as malignant tumors. Sex hormones may play a role in its pathogenesis, the prognosis is good.