子宫富于细胞平滑肌瘤和子宫内膜间质肉瘤中肥大细胞的研究

目的　探讨肥大细胞在子宫富于细胞平滑肌瘤和子宫内膜间质肉瘤鉴别诊断中的意义及其作用机制。方法　选取 2 5例子宫富于细胞平滑肌瘤和 2 6例子宫内膜间质肉瘤标本 ,用免疫组化SP法检测两种组织中肥大细胞和增殖细胞核抗原PCNA的表达 ,同时检测富于细胞平滑肌瘤中雌激素受体和CD4 4v3的表达。结果　子宫富于细胞平滑肌瘤和子宫内膜间质肉瘤之间PCNA表达差异无显著性 (P >0 .0 5 ) ,而肥大细胞计数差异有显著性 (P <0 .0 1) ,用肥大细胞 <7/HPF诊断子宫内膜间质肉瘤的灵敏度为 10 0 % ,特异度为 92 .0 %。富于细胞平滑肌瘤中肥大细胞计数与CD4 4v3存在正相关 (rs=0 .5 89,P <0 .0 1) ,而肥大细胞数与PCNA和ER均无相关。结论　肥大细胞数可用来鉴别子宫富于细胞平滑肌瘤和子宫内膜间质肉瘤 ,但肥大细胞在子宫富于细胞平滑肌瘤中增加的机制及其作用尚待进一步研究。     

Survivin和Caspase-3在子宫平滑肌肿瘤中表达的意义

 目的　探讨Survivin和Caspase-3在子宫平滑肌肿瘤中的表达及其意义,在富于细胞型平滑肌瘤和子宫平滑肌肉瘤的鉴别诊断中的意义。方法　采用免疫组织化学二步法分别检测30例富于细胞型子宫平滑肌瘤细胞、10例正常子宫平滑肌细胞、10例普通型子宫平滑肌瘤细胞、15例子宫平滑肌肉瘤细胞中Survivin和Caspase-3的表达。结果　Survivin在正常子宫肌层组织中仅有个别弱表达,在子宫普通型平滑肌瘤、富于细胞型平滑肌瘤、平滑肌肉瘤中的表达呈上升趋势,且普通型组和肉瘤组差别有统计学意义（P＜0.05）;而Caspase-3在正常子宫肌层、普通型平滑肌瘤、富于细胞型平滑肌瘤、平滑肌肉瘤中的表达呈下降趋势,且正常组与富于细胞型组、正常组与肉瘤组之间差异有统计学意义（P＜0.05）。结论　Survivin可能通过抑制Caspase-3的活性来抑制细胞凋亡,延长细胞寿命,从而在子宫平滑肌肿瘤由良性发展为恶性的过程中发挥重要作用。 二者联合检测有助于子宫平滑肌肿瘤之间的鉴别诊断。     

子宫内膜间质肉瘤的临床病理和免疫组织化学分析

目的：探讨子宫内膜间质肉瘤（endometrial stromal sarcoma,ESS）的临床病理及免疫组织化学特点及其在鉴别诊断中的意义。方法：采用HE和免疫组化SP法对20例ESS和10例子宫高度富于细胞平滑肌瘤（highly cellularleiomyoma,HCL）进行组织病理学及免疫组化对比分析。结果：ESS瘤细胞与增殖期子宫内膜的间质细胞相似;HCL瘤细胞呈圆形、梭形,可见大的厚壁血管。免疫组化染色,ESS瘤细胞CD10、SMA、MSA及Desmin的阳性率分别为100%、30%、20%及25%,而HCL相应的阳性率则为20%、100%、100%及100%。这些抗体在两组肿瘤间的表达差异有统计学意义,P〈0.001。结论：ESS具有特殊形态特点,有向平滑肌分化的能力。CD10、SMA、MSA及Desmin的联合应用是鉴别ESS与HCL有用的免疫组织化学标志,CD10蛋白是一种相对特异的子宫内膜间质标记物,在子宫肿瘤中可以区别ESS和HCL。     

Bcl-2及Ki-67蛋白在不同类型子宫平滑肌肿瘤中的表达情况

目的 探讨Bcl-2及Ki-67蛋白在不同类型子宫平滑肌肿瘤中的表达情况.方法 将子宫平滑肌肿瘤患者92例,按照良恶性的不同分为良性平滑肌瘤组(49例)、富于细胞型平滑肌瘤(32例)以及典型子宫平滑肌肉瘤(11例).将标本制成石蜡切片,采用免疫组织化学SP法检测标本中Bcl-2蛋白及Ki-67蛋白的表达情况.结果 患者平均年龄良性平滑肌瘤组最小,子宫平滑肌肉瘤组最高,组间比较均有统计学差异(P＜0.05).良性平滑肌瘤组Bcl-2阳性率最高,Ki-67阳性率最低;子宫平滑肌肉瘤组Bcl-2阳性率最低,Ki-67阳性率最高,组间比较均具有统计学差异(P＜0.05).Bcl-2在不同复发情况、肿瘤数量及肿瘤大小的患者中差异无统计学意义(P＞0.05),但Ki-67在复发、多发及肿瘤体积较大患者中阳性率较高,差异有统计学意义(P＜0.05).Bcl-2蛋白与Ki-67蛋白表达存在显著负相关(γ=-0.564,P=0.000).结论 Bcl-2及Ki-67蛋白在不同类型子宫平滑肌肿瘤中表达情况各异,二者呈负相关性,可联合用于子宫平滑肌肿瘤的辅助鉴别诊断.     

SMA、Desmin、CD10和Vimentin在特殊类型子宫肿瘤诊断中的应用

[目的]探讨SMA、Desmin、CD10和Vimentin在特殊类型子宫肿瘤诊断中的应用价值。[方法]收集特殊类型子宫肿瘤76例（子宫内膜间质肉瘤20例,癌肉瘤17例,平滑肌肉瘤10例,非典型平滑肌瘤16例,上皮样平滑肌瘤13例）,免疫组化SP法检测各组织中平滑肌肌动蛋白（SMA）、结蛋白（Desmin）、CD10和波形蛋白（Vimentin）的表达。[结果]CD10与Vimentin在子宫内膜间质肉瘤和癌肉瘤中高表达,SMA和Desmin在非典型平滑肌瘤和上皮样平滑肌瘤中高表达,Vimentin在平滑肌肉瘤中高表达。[结论]SMA、Desmin、CD10和Vi-mentin在特殊类型子宫肿瘤的诊断中有重要意义。     

子宫内膜间质肉瘤的形态及免疫组化分析

目的　研究子宫内膜间质肉瘤（ＥｎｄｏｍｅｔｒｉａｌＳｔｒｏｍａｌＳａｒｃｏｍａ，ＥＳＳ） 的组织学形态和免疫组化表达。　方法　应用常规ＨＥ染色、免疫组化标记和组化染色对１６ 例ＥＳＳ及１０ 例正常子宫内膜、肌组织进行回顾性研究。　结果　ＥＳＳ细胞的组织形态、免疫组化和组化染色表达与正常子宫内膜间质细胞相似，部分ＥＳＳ及正常子宫内膜间质细胞中ａｃｔｉｎ 表达阳性。　结论　ＥＳＳ的组织发生来自子宫内膜间质细胞，ＥＳＳ及子宫内膜间质细胞具有向平滑肌分化的能力。ＥＳＳ与平滑肌肿瘤的鉴别诊断主要根据各自的形态特点，肌源性标记呈强阳性，以及Ｍａｓｓｏｎ 三色染色显示红色反应，有助于平滑肌肿瘤的诊断     

子宫内膜间质肉瘤的开矿及免疫组化分析

目的 研究子宫内膜间质肉瘤的组织学形态和免疫组化表达。方法 应用常规ＨＥ染色、免疫组化标记和组化染色对１６例ＥＳＳ及１０例正常子宫内膜、肌组织进行回顾性研究。结果 ＥＳＳ细胞的组织形态、免疫组化染色表达与正常子宫内膜间质细胞相似，部分ＥＳＳ及正常子宫骨膜间质细胞中ａｃｔｉｎ表达阳性。结论 ＥＳＳ的组织发生来自子宫骨膜间质细胞，ＥＳＳ及子宫骨膜间质细胞具有向平滑肌分化的能力。ＥＳＳ与平滑肌肿瘤的鉴别     

低度恶性子宫内膜间质肉瘤临床病理分析

目的 探讨低度恶性子宫内膜间质肉瘤(LESS)的临床病理学特征、诊断和鉴别诊断.方法 分析7例LESS的临床病理特点,通过网织纤维染色、免疫组化染色研究其病理学特征.结果 LESS临床上主要表现为阴道不规则流血.瘤细胞类似于增生期子宫内膜间质细胞,形态较一致,圆形或卵圆形,少数为短梭形,胞质较少,胞核圆形或不规则形,核染色质较细.肿瘤内有大量丛状生长的分支状小的、薄壁的血管,类似于子宫内膜的螺旋动脉,部分肿瘤血管透明变性呈星状或放射状结构.网织纤维染色见网状纤维丰富,围绕瘤细胞生长.肿瘤细胞7例CD 10阳性,5例ER阳性,6例PR阳性,2例actin阳性,CD34、CDll7、Melan-A肿瘤细胞均阴性.结论 LESS易误诊为子宫内膜间质结节、未分化子宫内膜间质肉瘤、富于细胞性平滑肌瘤、静脉内平滑肌瘤病及血管周上皮样细胞肿瘤,确诊主要依靠组织病理学和免疫组织化学.     

子宫平滑肌肉瘤23例病理分析

子宫平滑肌肉瘤是子宫较常见的恶性肿瘤 ,可原发于子宫平滑肌组织 ,也可由子宫平滑肌瘤恶变而来。具有病程短、恶性度高等特点 ,发病年龄较平滑肌瘤高 ,平均为 54岁。现将我院 10年间收治的 2 3例子宫平滑肌肉瘤的临床病理资料进行综合性分析 ,以探讨诊断治疗子宫平滑肌肉瘤的经验方法。1　材料与方法1 1　一般资料　自 1989年至 1999年 10年间我院共收治子宫平滑肌肉瘤 2 3例 ,均经病理证实。1 2　症状与体征及术前诊断　 2 3例中 ,首发症状为经量增多或阴道异常出血者 10例 ,其中 9例发生于绝经后 ,1例发生于更年期 ,下腹肿物 2例 ,子宫肌…     

特殊类型的子宫平滑肌瘤30例分析

特殊类型的子宫平滑肌瘤,临床上较少见,是指富于细胞性、奇异性、透明性子宫肌瘤、血管性平滑肌瘤、淋巴性平滑肌瘤以及脂肪平滑肌瘤等[1-2],易与子宫肉瘤相混淆,但其临床表现为良性,现将我院收治的特殊肌瘤30例资料进行回顾分析,讨论其诊断及治疗问题.     

免疫组织化学标记在子宫内膜间质肉瘤诊断和治疗中的价值

 目的 探讨免疫组织化学标记在子宫内膜间质肉瘤（ESS）中的表达及其在诊断和治疗中的价值。方法 用免疫组织化学EnVision二步法对15例原发及3例转移复发ESS进行CD10、SM-MHC、h-caldesmon、AE1／3、CD99、Ki-67、CD34、c-kit、ER、PR的检测，并与其病理组织形态、临床并发症、鉴别诊断及预后对照。结果 17例CD10阳性，其中13例强阳性，7例伴平滑肌分化，3例伴上皮样分化，7例伴性索样分化；ER13例阳性，PR16例阳性； Ki-67 36 %～78 %。结论 子宫内膜间质肿瘤可伴多方向分化，主要为平滑肌和性索样分化；CD10是诊断子宫间质肿瘤的特异抗体，结合组织形态及SM-MHC、h-caldesmon等标记可增加其特异性；ER、PR常规检测主要用于指导孕激素辅助治疗。     

101例胃肠道间质性肿瘤的免疫组织化学研究——组织发生学的探讨

本文通过101例胃肠道间质性肿瘤(GIST)的免疫组化研究,以探讨其组织发生学问题。所有病例均作Vimentin,HHF—35,Desmin和S—100蛋白的检测。在HHF—35和Desmin均阴性的29例,加染Neurofilament和GFAP。并选择了12例胃肠道外的平滑肌肿瘤对比。101例中,94％Vimentin阳性(良性94.6％,恶性93.8％),65.3％HHF—35阳性(良性67.6％,恶性64％),23.8％Desmin阳性(良性37.8％,恶性15.6％)和22.8％S—100蛋白阳性(良性27％,恶性20.9％)。在HHF—35和Desmin均阴性的29例Neurofilament和GFAP均阴性。支持大多数GIST是平滑肌来源的肿瘤。对比正常胃肠道壁和血管壁的平滑肌以及胃肠道外的平滑肌肿瘤,其对HHF—35和Desmin的反应明显较弱,可能是因瘤细胞分化处于早期阶段有关。文中分析了各部位和各组织学类型的GIST与其抗原表达的差异,发现与肿瘤分化有关,亦与部位有关,食道发生的常是分化很好的平滑肌肿瘤,胃、肠的分化差异较大,即使组织学上为典型的平滑肌瘤,其对HHF—35和Desmin的表达较食道的差。部分GIST对HHF—35反应阳性而Desmin阴性,尤以恶性者。提示HHF—35对发现分化较差的肌肉源性肿瘤较Desmin为敏感。     

Aberrant expression of HMGA2 in uterine leiomyoma associated with loss of TSC2 tumor suppressor gene function

Unregulated proliferation of mesenchymal cells in leiomyomas, lipomas, hamartomas,and other diseases has been linked to the high mobility group (HMGA) family of DNA architectural proteins. HMGA genes are primarily expressed during embryonal development and silenced in adult tissues but can become reactivated in neoplasia as a result of chromosomal rearrangements. Although the genetic data suggesting a role for HMGA proteins in tumorigenesis are compelling, the biological role of these proteins in mesenchymal proliferation and differentiation is incompletely defined. Uterine myometria and spontaneous leiomyomas from the Eker rat, which carries a germ-line mutation in the tuberous sclerosis complex-2 (Tsc2) tumor suppressor gene, were analyzed for genetic defects in and expression of the Tsc2 and HMGA proteins. Eker leiomyomas exhibited a 50% incidence of loss of the wild-type Tsc2 allele and an almost uniform loss of protein expression, implicating loss of function of the Tsc2 gene in these tumors. Concomitantly, HMGA2 protein, which was completely absent in normal myometria, was expressed in 16 of 19 Eker leiomyomas. HMGA1 was expressed in both leiomyoma and normal myometria. No structural alterations were observed at the HMGA2 locus in either primary rat leiomyomas or leiomyoma-derived cell lines that expressed HMGA2. These data support a role for HMGA2 in the development of smooth muscle neoplasms and suggest HMGA2 expression is a point of convergence between the human disease and the Eker rat model. Furthermore, these data indicate that aberrant HMGA2 expression can result from dysfunction of the Tsc2 tumor suppressor gene, in the absence of structural alterations involving the HMGA2 locus.     

肺良性转移性平滑肌瘤1例报道及文献复习

目的探讨肺良性转移性平滑肌瘤的临床病理特征，组织发生及鉴别诊断。方法通过光镜、免疫组化染色，对一例肺良性转移性平滑肌瘤的病理学特点进行观察，并进行文献复习。结果巨检：楔形肺组织大小3cm×2cm×1cm，切面暗红，可见一直径0．5cm大小的结节，界清。光镜特点：瘤细胞为长梭形，呈束状、交织状排列，胞浆淡染，胞核梭形、类圆形，两端钝圆，染色质较粗，轻度异型，未见核分裂像。瘤组织与周围组织分界清楚，周边部为单层立方上皮细胞，瘤组织内可见上皮细胞衬里的裂隙，周围可见受挤压的肺泡结构。免疫组化特点-梭形瘤细胞SMA、Desmin、Vimentin、ER（个别细胞）、PR阳性，CK7、CK20、CD31、CD34、HMB45均阴性。结论肺良性转移性平滑肌瘤是一种来源于子宫平滑肌瘤的良性肿瘤，非常罕见，诊断时必须结合病史、影像学检查、病理组织学及免疫组织化学特点才能做出诊断。     

Telomerase activity in needle biopsied uterine myoma-like tumors: differential diagnosis between uterine sarcomas and leiomyomas.

Preoperative differential diagnoses between uterine sarcomas and leiomyomas are difficult. As telomerase activation is thought to be essential for the immortality of malignant cells, it is considered a potentially useful diagnostic marker. The aim of the present study was to evaluate the potential diagnostic use of measuring telomerase activity in needle biopsy samples to distinguish uterine sarcoma from leiomyoma. Sixty-two patients with suspected uterine sarcomas based on clinical findings or magnetic resonance imaging findings, and who were scheduled for surgery, underwent transcervical ultrasound-guided needle biopsy. Three samples were obtained per patient for histopathological examination and telomerase activity measurement. Telomerase activity was measured using the telomeric repeat amplification protocol and correlated with final histopathological findings of surgical specimens. Of the 62 patients, 6 leiomyosarcomas and 1 endometrial stromal sarcoma (high grade) were diagnosed by histopathology. In 6 of the 7 samples from uterine sarcomas, relatively high telomerase activity (22-102 units) was detected, whereas only low telomerase activity (11-18 units) existed in 3 of the remaining 55 samples from benign or borderline uterine smooth muscle tumors. At a cut-off value of 20 units, sensitivity, specificity, positive predictive, and negative predictive values for detecting uterine sarcoma were 86% (95% confidence interval, 59-100%), 100% (94-100%), 100% (54-100%) and 98% (95-100%), respectively. The results indicated that telomerase activity in needle biopsy samples is a useful diagnostic marker to distinguish uterine sarcoma from leiomyoma.     

Expression of cyclins and cyclin-dependent kinases in smooth muscle tumors of the uterus.

To investigate the cell cycle regulatory mechanisms involved in the growth of smooth muscle tumors, we studied the expression of Ki-67, cyclins E and A, and their catalytic partners, the cyclin-dependent kinases cdk2 and cdc2 by using tissue specimens from benign and malignant smooth muscle tumors. These included 20 cases of usual leiomyoma (UL), 18 of cellular leiomyoma (CL), 8 of bizarre leiomyoma (BL), 8 of uncertain malignant potential tumors (UMP) and 20 of leiomyosarcoma (LMS). The proliferation rate detected by Ki-67 was low in normal myometrium and leiomyomas (UL, CL and BL), but it was markedly increased in LMS. The expression of the cyclins (E and A) and cdks (cdk2 and cdc2) was also low in normal myometrium and leiomyomas. However, the expression of these factors was markedly increased in LMS. In addition, a survival analysis using Log-rank test, revealed that LMSs with positive staining for cyclin A and with diffusely staining for cyclin E were associated with significantly shorter survival. Our results suggest that expression of cyclins and cdks may be involved in the growth control of uterine smooth muscle tumors.     

A clinicopathologic and immunohistochemical study of gastrointestinal stromal tumors.

The clinicopathologic and immunohistochemical features in 120 cases of gastrointestinal stromal tumor (GIST) were reviewed. Excluding 24 cases of gastric schwannoma, 96 cases of GIST consisting of 62 benign tumors and 34 sarcoma (low grade, 17; high grade, 17), with 9 cases arising in the esophagus, 57 in the stomach, 28 in the small intestine, and 2 in the colon, were studied. All esophagus and colon tumors were benign and resembled a conventional leiomyoma histologically. However, the gastric and small intestine benign tumors mostly showed histologic features of cellular or epithelioid leiomyoma. Immunohistochemically, desmin caused a positive reaction in all esophagus and colon tumors, but only 26% of gastric and small intestine tumors. However, muscle-specific actin (HHF35) caused a positive reaction in most GIST (92%). The 10-year survival rates of the patients with gastric sarcoma and those with intestinal sarcoma were 74% and 17%, respectively. These results showed that histologic and immunohistochemical features were distinctly different, depending on the location in the gastrointestinal tract; that most GIST, excluding schwannoma, had smooth muscle differentiation; and that sarcomas had a more favorable prognosis when they occurred in the stomach rather than the intestine.     

从与血管的关系中探讨子宫平滑肌瘤的组织发生

采用ＨＥ染色、Ｇｏｍｏｒｉ网状纤维染色、显示血管内皮细胞标记抗原（第八因子相关抗原）的免疫组织化学染色，观察子宫平滑肌瘤和胎儿子宫肌层组织的血管及其周围的幼稚细胞团。结合有关文献认为：已分化的血管内皮细胞不向平滑肌细胞分化；新生的细小血管壁平滑肌细胞与平滑肌瘤细胞共同起源于未分化的间充质细胞；胚胎时期，这些未分化的间充质细胞可分化形成子宫平滑肌细胞。