摘要
Abstract
Purpose To investigate the clinical characteristics, pathological features, diagnosis, differential diagnosis, and prognosis of endometrial stromal sarcoma ( ESS ). Methods Nine patients with ESS were analyzed on their clinical and pathological manifestations, key markers in immunohistochemistry, and follow-up. Results Patients aged from 39 to 64 years with a median age of 46. 3 years. Major clinical manifestations consisted of vaginal bleeding and enlarged uterus or occupied lesions in uterus. Diameters of these tumors varied from 2. 3 to 11 cm with the average of 4. 6 cm. Under light microscope, eight cases were diagnosed as low-grade of endometrial stromal sarcoma ( LGESS ), because these uterus were composed of endometrial stromal tumor cells which likely transformed from normal stromal cells in proliferation stage. Meanwhile, tumor cells densely populated without obvious atypia, invaded muscle layers with tongue-like, or irregular island-like shapes. There were also a lot of small and thin-walled spiral blood vessels in those tissues. One case was diagnosed as high-grade of endometrial stromal sarcoma or undifferentiated endometrial sarcoma ( HGESS/UES ), based on almost replacement of myometrium with tumor cells, and significant cellular atypia without small blood vessels which were common in LGESS. Immunohistochemical results showed that all tumor cells expressed both CD10 and vimentin, and most tumors expressed PR and ER. Meanwhile, SMA, desmin and h-caldesmon were only positive in a few tumor cells, but S-100, CD34 were negative. Seven patients were followed up after operation for an average of 53 months, only 1 case of HGESS/UES died. Conclusions ESS is a rare cancer involved in female genital tract. Malignant degree varies significantly among different patients. Accurate diagnosis mainly depends on the clinical features, histopathology, with help of a comprehensive analysis by immunohistochemistry. This disease should be discriminated from endometrial stromal nodules, smooth muscle tumors, and poorly differentiated carcinoma.关键词
子宫肿瘤/子宫内膜间质肉瘤/免疫组织化学/鉴别诊断Key words
uterine neoplasms/ endometrial stromal sarcoma/ immunohistochemistry/ differential diagnosis分类
医药卫生
