CAJ | 학술논문

目的：探讨复发性子宫苗勒源腺纤维瘤的临床病理学特征及鉴别诊断要点。方法回顾性复习1992年1月至2006年4月7例复发性子宫腺纤维瘤患者的临床病理资料，比较肿瘤复发前后组织学形态特点及变化，同时选择经随访临床经过良性的腺纤维瘤12例和低级别腺肉瘤14例，进行免疫组织化学EnVision法染色，比较雌激素受体（ ER）、孕激素受体（ PR）、平滑肌肌动蛋白（ SMA）、CD10、p53及Ki-67的表达情况。结果7例复发性腺纤维瘤均表现为宫腔或宫颈外生性广基分叶状赘生物，镜下原发肿瘤由良性上皮及良性间叶成分混合组成，间质细胞核分裂象≤1/10 HPF。复发肿瘤中3例保持良性形态，4例伴有局部腺肉瘤改变。 ER、PR、SMA及p53在良性腺纤维瘤、复发性腺纤维瘤和低级别腺肉瘤中的表达差异无统计学意义。 CD10在良性腺纤维瘤及复发腺纤维瘤中通常不表达或仅有局灶弱表达（分别为1/12和1/7），而在腺肉瘤中有较高的表达比例（9/14，P＜0.05）。3组的Ki-67阳性指数差异无统计学意义（P＞0.05），但腺肉瘤中Ki-67在腺体周围间质带表达强于腺体之间的间质，腺纤维瘤则无此现象。结论复发性腺纤维瘤可能具有未确定的生物学行为或交界性特征，与低级别腺肉瘤鉴别诊断困难，CD10及Ki-67免疫组织化学染色可能有助于诊断。
목적：탐토복발성자궁묘륵원선섬유류적림상병이학특정급감별진단요점。방법회고성복습1992년1월지2006년4월7례복발성자궁선섬유류환자적림상병리자료，비교종류복발전후조직학형태특점급변화，동시선택경수방림상경과량성적선섬유류12례화저급별선육류14례，진행면역조직화학EnVision법염색，비교자격소수체（ ER）、잉격소수체（ PR）、평활기기동단백（ SMA）、CD10、p53급Ki-67적표체정황。결과7례복발성선섬유류균표현위궁강혹궁경외생성엄기분협상췌생물，경하원발종류유량성상피급량성간협성분혼합조성，간질세포핵분렬상≤1/10 HPF。복발종류중3례보지량성형태，4례반유국부선육류개변。 ER、PR、SMA급p53재량성선섬유류、복발성선섬유류화저급별선육류중적표체차이무통계학의의。 CD10재량성선섬유류급복발선섬유류중통상불표체혹부유국조약표체（분별위1/12화1/7），이재선육류중유교고적표체비례（9/14，P＜0.05）。3조적Ki-67양성지수차이무통계학의의（P＞0.05），단선육류중Ki-67재선체주위간질대표체강우선체지간적간질，선섬유류칙무차현상。결론복발성선섬유류가능구유미학정적생물학행위혹교계성특정，여저급별선육류감별진단곤난，CD10급Ki-67면역조직화학염색가능유조우진단。
Objective To study the clinicopathologic features and differential diagnosis of recurrent Müllerian adenofibroma ( MAF) of the uterus.Methods Clinicopathologic information of 7 cases of recurrent MAF of uterus was retrieved from January 1992 to April 2006 and compared with 12 cases of MAF without recurrence and 14 cases of low-grade Müllerian adenosarcoma ( MAS ). EnVision immunohistochemistry of estrogen receptor ( ER ) , progesterone receptor ( PR ) , smooth muscle actin (SMA), CD10, Ki-67 and p53 were performed in all cases.Results All cases of recurrent MAF of the uterus were polypoid , lobulated, and broad based mass arising from the corpus or cervix .Microscopically , the tumor consisted of benign epithelial and mesenchymal components with low mitotic activity (≤1/10 HPF) .The clinical and pathologic features of 3 recurrent tumors were similar to their primary tumors , while 4 cases of recurrent tumor presented with focally higher cellularity and mitotic activity , meeting the diagnostic criteria of adenosarcoma .The stromal expression patterns of ER , PR, SMA and p53 in recurrent MAF were similar to those of clinically benign MAF and low-grade MAS.Negative or focally positive stromal cell expression of CD10 was seen infrequently in recurrent MAF (1/7) and clinically benign MAF (1/12). In contrast, a moderate to strong CD10 staining was frequently seen in MAS (9/14, P <0.05).The difference of Ki-67-labeling index between MAF and MAS did not reach a statistical significance ( P >0.05 ) . Ki-67-labeling index increased in areas of periglandular stromal cuffing as compared with interglandular areas in all MAS cases , but it was not observed in either recurrent MAF or clinically benign MAF cases.Conclusions Recurrent MAF may be associated with aggressive behavior .It is difficult to distinguish MAF from low-grade MAS.CD10 and Ki-67 staining pattern in stromal cells may be helpful for the differential diagnosis .