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目的探讨子宫上皮及间叶混合性肿瘤(MMT)的临床病理特征。方法选择符合WHO 组织学分类中关于子宫 MMT 诊断标准的患者共102例,包括良性 MMT 77例(其中复发性患者9例)、恶性 MMT 25例(其中高度恶性7例),对其临床表现、病理特点及随访资料进行回顾性分析。结果 (1)临床表现:良性 MMT 多以发现宫腔或宫颈赘生物为主诉,部分伴有月经改变或绝经后阴道出血,临床上常常误诊为黏膜下平滑肌瘤;低度恶性 MMT 与良性 MMT 症状相似,临床上常不能分辨;高度恶性 MMT 表现为持续阴道出血或流液、下腹疼痛、子宫肿块等,B 超、CT 提示有肌层浸润。(2)病理检查:①大体观:良性 MMT 表现为外生性赘生物,蒂部较宽,与基底组织层延续或有一定分界;低度恶性 MMT 肉眼不能分辨;高度恶性 MMT 与癌和肉瘤相似。②镜下观:肿瘤由上皮及间叶成分混合组成,分别根据其不同良、恶性成分的组合命名。(3)复发性 MMT 的临床病理特点:复发性腺纤维瘤具有良性组织形态、临床局部复发的特点,复发时间为3个月～8年,组织学表现与腺肉瘤难以鉴别。结论符合 WHO 组织学诊断标准的 MMT 并不少见,鉴别诊断要结合多因素全面分析。复发性腺纤维瘤可能具有交界性肿瘤的特征。
Objective To investigate the clinicopathological features of mixed uterine epithelium and mesenchymal tumor (MMT). Methods A total of 102 patients were selected according to WHO criteria for diagnosis of uterine MMT, including 77 patients with benign MMT (including 9 patients with recurrent MMT) and 25 patients with malignant MMT (7 patients were highly malignant). The clinical manifestations, Pathological features and follow-up data were retrospectively analyzed. Results (1) Clinical manifestations: Benign MMT mostly to find the uterine cavity or cervical neoplasms chief complaint, some with menstrual changes or vaginal bleeding after menopause, clinically misdiagnosed as submucous leiomyoma; low-grade MMT and benign MMT Symptoms are similar, often can not be distinguished clinically; high-grade MMT manifested as persistent vaginal bleeding or fluid, abdominal pain, uterine mass, etc., B-ultrasound, CT prompted myometrial invasion. (2) pathological examination: ① general view: benign MMT showed exogenous vegetation, wide pedicle, and the basal tissue layer continuation or a certain demarcation; low-grade MMT can not distinguish the naked eye; high-grade MMT and cancer and sarcoma similar . Microscopic view: The tumor consists of a mixture of epithelial and mesenchymal components, respectively, according to their combination of different benign and malignant components named. (3) The clinicopathological features of recurrent MMT: recurrent adenofibroma has the characteristics of benign tissue morphology and clinical local recurrence, the recurrence time is 3 months to 8 years, histological manifestations and adenosarcoma is difficult to identify. Conclusion It is not uncommon for MMT in line with WHO histological diagnostic criteria to be combined with multifactorial comprehensive analysis in differential diagnosis. Recurrent glandular fibroids may have borderline tumor characteristics.