子宫浆液性癌及内膜上皮内癌临床病理分析

目的探讨子宫浆液性癌(USC)及内膜上皮内癌(EIC)的组织病理学特点及鉴别诊断。方法回顾性分析13例USC和1例EIC的临床和病理学特点,并进行免疫组化染色观察p53、ER和PR在肿瘤细胞中的表达。结果患者年龄60～77岁(平均68岁),临床多表现为绝经后不规则阴道流血。随访10例,6例死亡,生存5～28个月(平均14个月);4例仍存活(11～36个月)。9例为单纯USC,4例混合有其他类型内膜腺癌成分。形态上,9例USC以有纤维血管轴心的宽乳头为主,被覆异型性明显的多角形或鞋钉样细胞,2例肿瘤大部分为纤细的乳头结构,1例以腺管状结构为主。2例表现为息肉表面的EIC,无间质浸润和腺体融合。3例USC的浸润成分以腺管结构为主。7例USC伴有EIC,其中2例宫颈内口、1例输卵管黏膜也可见上皮内癌改变。免疫表型:12例USC和所有EIC病变的非典型细胞对p53呈弥漫性强阳性反应,各有1例USC有ER、PR阳性表达。结论USC结构有一定的多样性,可以表现为分化好的腺管状结构。内膜活检标本中发现EIC改变时,提示可能有USC存在。应仔细检查绝经后妇女的内膜息肉以排除EIC改变。p53、ER、PR免疫组化染色有助于鉴别诊断。

Clinicopathological study of uterine serous carcinoma and endometrial intraepithelial carcinoma

Purpose To investigate the histopathologic features of uterine serous carcinoma(USC) and endometrial intraepithelial carcinoma (EIC) as well as their differential diagnoses. Methods Thirteen cases of USC and 1 case of EIC were retrospectively analyzed. Immunohistochemical staining for p53, estrogen receptor (ER) and progesterone receptor (PR) was performed. Results The ages of patients ranged from 60 to 77 years (mean 68 years). The most common symptom was irregular postmenopausal vaginal bleeding. In 10 patients with follow-up information, 4 were alive for 11~36 months after the operation, 6 patients died, and their average survival being 14 months. Nine cases were pure USC, four admixed with other types of endometrial carcinoma. Morphologically, 9 cases of USC were characteristics of thick fibrovascular papillae covered by polygonal or hobnail shaped cells with marked nuclear atypia, while 2 cases were predominantly thin and delicate papillae and one with glandular architecture. Two cases were pure EIC on the surface of polyps without evidence of glandular confluence or stromal invasion. The invasive component of 3 cases of USC showed a prominent glandular pattern. EIC was also observed in the atrophic endometrium in 7 cases of USC. Intraepithelial carcinoma resembling in situ carcinoma was detected in the endocervix of two cases and the mucosa of the fallopian tube in one case. Immunohistochemically, 12 cases of USC and the atypical cells of EIC were diffusely positive for p53 protein. ER and PR expression was observed in only one case of USC, respectively. Conclusions USC displays considerable morphologic diversity. It could exhibit architecturally well-differentiated tubular glands. The presence of EIC in endometrial biopsies or curettings suggests that there may be associated with uterine serous carcinoma. Caution should be given to endometrial polyps of postmenopausal women to exclude EIC change. Immunohistochemical staining of p53, ER and PR is helpful in differential diagnosis.