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目的探讨子宫内膜间质肉瘤(ESS)和转移复发瘤组织形态与免疫组织化学染色特点,及其肿瘤分化特点和鉴别诊断。方法观察15例子宫原发ESS及4例转移复发瘤的组织形态,并用免疫组织化学EnVisonTM二步法检测CD10、平滑肌肌动蛋白(SMA)、雌激素受体(ER)、孕激素受体(PR)、AE1/3及α-抑制素的表达,以10例富于细胞平滑肌瘤作对照。结果15例患者发病年龄22～75岁(平均45岁)。组织学分型:7例经典型,3例平滑肌分化型,2例纤维黏液型,3例分化差型,细胞异型明显。4例复发转移瘤中3例组织形态与原发瘤不同。免疫组织化学染色阳性结果:在14例ESS及4例复发转移瘤中CD1015/18、SMA5/18、ER7/18、PR10/18;AE1/3和α-抑制素仅在腺样分化区阳性。平滑肌瘤对照组CD10为1/10、SMA为10/10,表达差异均有统计学意义(P<0.05)。结论ESS多向分化的特点使其呈现多样的组织形态,且转移复发瘤形态可与原发瘤不同。CD10与SMA联合应用有助于ESS的诊断和鉴别诊断。
Objective To investigate the histomorphologic and immunohistochemical staining of endometrial stromal sarcoma (ESS) and metastatic recurrence tumor, and its differentiation characteristics and differential diagnosis. Methods The morphology of 15 cases of primary uterine ESS and 4 cases of metastatic neoplasm were observed. The expressions of CD10, SMA, estrogen receptor (ER) and progesterone receptor (ER) were measured by immunohistochemical EnVisonTM two - PR), AE1 / 3 and α-statin expression in 10 cases of cell-rich leiomyoma control. Results The onset age of 15 patients was 22-75 years (average 45 years). Histological typing: 7 cases of classic, 3 cases of smooth muscle differentiation, 2 cases of fibrous myxoid, 3 cases of poor differentiation, cell atypia. In 4 cases of recurrent tumor, the morphology of the 3 cases was different from that of primary tumor. Positive results of immunohistochemical staining: CD1015 / 18, SMA5 / 18, ER7 / 18, PR10 / 18 and AE1 / 3 and α-statin were positive only in the adenoid differentiation region in 14 ESS and 4 recurrent metastatic tumors. The leiomyoma control group CD10 was 1/10, SMA was 10/10, the expression difference was statistically significant (P <0.05). Conclusion The characteristics of multidirectional differentiation of ESS make it show a variety of morphological changes, and metastatic tumor morphology may be different with the primary tumor. The combination of CD10 and SMA contributes to the diagnosis and differential diagnosis of ESS.