低度恶性子宫内膜间质肉瘤临床病理特征及误诊原因探析

摘要

Objective:To investigate the clinical and pathological features of low-grade endometrial stromal sar-coma( LGESS),to improve the rate of the diagnosis of LGESS,determine the operable range,avoid the second-opera-tion. Methods:Two cases of LGESS were analyzed by means of reviewing the history records from April,2010 to April 2011 in our hospital and connecting the correlative report. Results:The main clinical symptoms of LGESS were irregu-lar vaginal bleeding,hypomenorrhea or postmenopausal,hypogastric pain,and occasionally touching a mass. The tumor cell resembled the endometrial stromal cell of proliferation phase on HE staining. There were a lot of blood vessels just like the spiral in the tumors. Two cases were positive for CD10,ER and PR by immunohistochemical findings. Conclu/sion:LGESS is very rare and easy to misdiagnosis,the diagnosis relies mainly on histopathological and immunohisto-chemical findings. The prognosis of LGESS is better. It is necessary of diagnostic curettage before operating. In operat-ing if we doubt sarcoma,we must rapid do histopathological examination. The curative effect of annexectomy and chemical therapy is better.%目的：探讨低度恶性子宫内膜间质肉瘤（ LGESS）的临床病理特征，提高LGESS早期诊断率，以确定手术范围，避免二次手术。方法：对2010年4月至2011年4月我院收治的2例LGESS病例临床及病理资料进行回顾性分析，结合相关文献报道。结果：低度恶性子宫内膜间质肉瘤临床表现为阴道不规则出血，月经过多或绝经后阴道流血、下腹痛，偶尔触及包块。HE染色见肿瘤细胞类似增生期子宫内膜间质细胞，螺旋小血管多见，免疫组化染色2例患者肿瘤细胞CD10、Vimentin、ER、PR均（＋）。结论：低度恶性子宫内膜间质肉瘤临床少见，易误诊，确诊主要依靠组织病理学和免疫组织化学。本病预后较好，术前诊断性刮宫是必要的，术中疑有恶性应送快速冰冻病理检查，采用全子宫及双附件切除，辅以化疗者疗效更好。