CAJ | 학술논문

目的探讨子宫出血性富于细胞性平滑肌瘤的临床病理特征,免疫学表型及鉴别诊断.方法分析4例子宫出血性富于细胞性平滑肌瘤的临床资料,观察常规HE切片的病理形态学特征, 应用免疫组化SP法检测vimentin、desmin、SMA、CD10、LCA、ER、PR和Ki-67,并复习相关文献.结果患者主要临床特征是下腹部包块及腹痛.镜下以瘤细胞丰富、核固缩深染及出血、坏死为特征.免疫组化显示瘤细胞CD10和LCA均(-),vimentin呈弱(+),desmin呈(+),SMA呈局灶性强(+);在分化较好的瘤细胞中3例ER呈弱(+),PR呈强(+);Ki-67增殖指数均<1%.核固缩的瘤细胞中各种抗体均为(-).结论子宫出血性富于细胞性平滑肌瘤是一种少见的平滑肌瘤类型,患者常有口服避孕药及与妊娠有关的病史,其镜下有独特的形态学特征.在做病理诊断时,应注意与子宫平滑肌肉瘤、子宫平滑肌瘤红色变性、子宫内膜间质肿瘤及子宫恶性淋巴瘤进行鉴别.
목적 탐토자궁출혈성부우세포성평활기류적림상병리특정,면역학표형급감별진단.방법 분석4례자궁출혈성부우세포성평활기류적림상자료,관찰상규HE절편적병리형태학특정, 응용면역조화SP법검측vimentin、desmin、SMA、CD10、LCA、ER、PR화Ki-67,병복습상관문헌.결과 환자주요림상특정시하복부포괴급복통.경하이류세포봉부、핵고축심염급출혈、배사위특정.면역조화현시류세포CD10화LCA균(-),vimentin정약(+),desmin정(+),SMA정국조성강(+);재분화교호적류세포중3례ER정약(+),PR정강(+);Ki-67증식지수균<1%.핵고축적류세포중각충항체균위(-).결론 자궁출혈성부우세포성평활기류시일충소견적평활기류류형,환자상유구복피잉약급여임신유관적병사,기경하유독특적형태학특정.재주병리진단시,응주의여자궁평활기육류、자궁평활기류홍색변성、자궁내막간질종류급자궁악성림파류진행감별.
Objective To investigate the clinicopathologic features, immunophenotyping and differential diagnoses of hemorrhagic cellular leiomyomas of the uterus. Methods The clinicopathologic features and immunohistochemical findings were analyzed in 4 cases of hemorrhagic cellular leiomyomas of the uterus, with review of the literature. Results The main clinical features of these patients were a below abdominal mass and abdominal pain. Microscopically, the tumors were characterized by a dense cellularity, karyopyknosis, hemorrhage and necrosis. Immunohistochemical staining revealed that all cases were negative for CD10 and LCA. In 3 cases with well differentiated cells, ER was weakly positive and PR was strongly positive, whereas all cases were focally strongly positive for SMA and positive for vimentin and desmin, with a low Ki-67 index (<1%). In the karyopyknosis cells, all antibodies were negative. Conclusion Hemorrhagic cellular leiomyoma of the uterus is a rare type of leiomyomas and usually associated with history of oral contraceptives or pregnancy. Microscopically, there are characteristic morphologic features in the tumor. It needs to be distinguished from leiomyosarcoma, red degeneration of leiomyomas, endometrial stromal tumours and malignant lymphoma.