14例子宫内膜非典型性息肉样腺肌瘤及癌变的临床病理分析

摘要

目的 探讨子宫内膜非典型性息肉样腺肌瘤(APA)的临床病理特点,并判断APA内癌变的诊断依据.方法 收集2007年1月至2013年3月在解放军总医院诊断为APA的患者14例,其中有4例APA内癌变患者,观察组织形态学改变并辅以免疫组化染色检查,同时进行相关文献的复习.结果 14例患者的临床表现以不规则阴道流血为主(4例),4例因不孕就诊时被发现.14例患者的中位年龄为38岁(23～72岁),仅1例发生于绝经后.4例APA内癌变患者的中位年龄为35岁(28～41岁),超声检查均显示血流信号丰富;其中3例行子宫切除术,1例失访.APA内癌变患者肿瘤平均直径4.7 cm,大于无癌变者(1.8 cm).镜下观察显示,APA内癌变者除了腺上皮不同程度的异型增生外,还出现明显的筛状、实性、条索及乳头等异常腺体形态,并出现粉刺样坏死.结论 APA是少见的子宫体病变,尽管多数患者预后良好,但如果病变直径超过4 cm,组织形态学出现大量的腺体融合、筛状结构、坏死及显著的异型性,应结合超声检查,警惕癌变可能.%Objective To analyze the clinicopathologic characteristics of atypical polypoid adenomyoma (APA) of endometrium,and investigate the special characteristics of cancerous transformation from APA.Methods Fourteen cases of APA were collected in General Hospital of People' s Liberation Army from January 2007 to March 2013.The clinical data,morphologic features,immunohistochemistry and the related literature were reviewed.Results The median age of the 14 patients was 38 years (ranged from 23 to 72 years),only 1 patient was postmenopausal.The most common symptom was irregular vaginal bleeding (4/14),and 4 patients were identified during routine physical examination for infertility.Among 14 cases,4 cases were diagnosed as well differentiated endometrioid adenocarcinoma originating from APA,and their median age was 35 years (ranged from 28 to 41 years); color Doppler flow imaging (CDFI) of ultrasound showed rich blood flow signal.The tumors with cancerous components were obviously larger than the usual APA (mean diameter:4.7 versus 1.8 cm).Histologically,irregular and branched glands were embedded in fibromuscular stroma and the glandular epithelium were atypical hyperplasia in varying degrees.While carcinoma developed in the APA,the sieve,solid and papillary structures were noticeable,and necrosis were common.Conclusions APA is a rare lesion of the uterus.Although the clinical behavior is benign in most cases,there may be possible for some cases developing carcinomas.If the APA mass is more than 4 cm in diameter,and microscopically demonstrates prominent sieve,solid,papillary structures and necrosis,the diagnosis of carcinoma developed from APA can be made.Thorough analysis should be done before the most proper therapeutic regimen is drawn up.