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目的探讨子宫苗勒腺肉瘤伴性索样分化(MASCE)的临床病理学特征、免疫表型、诊断与鉴别诊断。方法对1例MASCE进行HE和免疫组化染色,并复习相关文献。结果患者女性,56岁。绝经后阴道出血。巨检:肿瘤位于宫腔内,7 cm×4 cm×3 cm大小灰白色肿物,突向宫腔,切面灰红、灰白色,肿物基底部与子宫肌层界限尚清。镜检:肿瘤由良性腺体和富于细胞的间叶成分组成。良性腺体为子宫内膜样腺体,呈囊状扩张,部分腺体伴鳞状上皮化生。间质富于细胞,围绕腺体呈袖套状分布。间质成分类似于低级别子宫内膜间质肉瘤,有轻度异型,可见核分裂,核分裂象约2~3个/10HPF。肉瘤样间质内可见条索状、腺泡状排列的细胞,呈多角形,胞质较丰富或空泡状,细胞形态温和。免疫组化:腺上皮和间质细胞ER和PR(+),围绕腺体的梭形细胞CD10强(+),而远离腺体的梭形细胞CD10(-)。肉瘤样成分内的条索状和腺泡状排列的细胞inhibin-α(+),calretinin局灶性(+),而CD68、desmin、SMA、S-100蛋白和HMB45(-),Ki-67增殖指数为10%。结论 MASCE是一种比较少见的子宫上皮-间叶混合性肿瘤,生物学行为为低度恶性,需与子宫内膜间质肉瘤伴性索样分化和子宫性索样肿瘤等鉴别。
Objective To investigate the clinicopathological features, immunophenotypes, diagnosis and differential diagnosis of uterine cervix adenosarcoma associated with cord-like differentiation (MASCE). Methods One case of MASCE was stained with HE and immunohistochemistry, and the related literatures were reviewed. Results Patient female, 56 years old. Postmenopausal vaginal bleeding. Giant tumor: tumor located in the uterine cavity, 7 cm × 4 cm × 3 cm size gray-white mass, protruding to the uterine cavity, cut reddish gray, gray, tumor base and myometrium clear. Microscopic examination: The tumor consists of benign glands and cell-rich mesenchyme components. Benign glands for endometrioid glands, cystic dilatation, some glands with squamous metaplasia. Interstitial cells in the rich, around the glands are sleeve-like distribution. Interstitial components similar to low-grade endometrial stromal sarcoma, mild dysmorphosis, showing mitotic, mitotic figures about 2 ~ 3 / 10HPF. Sarcomatoid interstitial stroma can be seen in the stripe, alveolar cells arranged in a polygon, cytoplasm more abundant or vacuolar, mild cell morphology. Immunohistochemistry: The glandular epithelial and interstitial cells ER and PR (+) are strongly CD10 (+) around the glandular spindle cells and CD10 (-) from the glandular spindle cells. Inhibin-α (+) and calretinin were focal (+), while CD68, desmin, SMA, S-100 protein and HMB45 (-) and Ki-67 Proliferation index of 10%. Conclusions MASCE is a rare uterine epithelial-mesenchymal tumor with low malignant biological behavior. It needs to be differentiated from endometrial stromal sarcoma with cord-like differentiation and uterine cord-like tumor.