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- B1529大肠腺癌转移子宫内膜 in 60 y women without history (cqz 5)
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60 y/f had hysterectomy for endometrial lesion. Intraoperation evaluation: 4x3 cm endometrial tumor with 30% of myometrial invasion.
Now you have perminant H@E slides.
Key:
F1-2: 20x
F3: 40x
F4-6: 100x
标签：子宫内膜 大肠腺癌
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本帖最后由 于 2009-03-22 12:15:00 编辑
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大肠腺癌转移子宫内膜
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本帖最后由 于 2009-03-16 02:22:00 编辑
The pathologist did some IHC on endometrial biopsy specimen (biopsy performed in other hospital) and found some surprise pattern. The stains were performed on the hysterectomy specimen also. IHC result seen below.
Key:
f1. CK7
f2. CK20
f3. CDX2
f4. ER
f5. PR
f6. Vimentin
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More recent history: The patient was present with vaginal bleeding. Endonetrial biopsy was performed in outside hospital and diagnosed as endometrial carcinoma, nuclear grade 2. The women came to our hospital to see gynecologist. The slides of outhospital were sent to our hospital for evaluation. The patient had hysterectomy before our pathologist signed out the case.
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本帖最后由 于 2009-03-10 12:40:00 编辑
A good paper about APA from Stanford more than 10 years ago
Am J Surg Pathol. 1996 Jan;20(1):1-20.10年前一篇非常好的文章
Atypical polypoid adenomyofibromas (atypical polypoid adenomyomas) of the uterus. 子宫非典型性的息肉样腺肌瘤A clinicopathologic study of 55 cases.55例临床病理分析
Longacre TA, Chung MH, Rouse RV, Hendrickson MR.
Division of Surgical Pathology, Stanford University Medical Center, CA 94305, USA.We present the clinicopathological and immunohistochemical features of 55 atypical polypoid adenomyofibromas, a definitional expansion of an entity previously reported as "atypical polypoid adenomyoma" (APA) of the uterus.我们报告55例子宫非典型性的息肉样腺肌瘤，并且做了免疫组化和临床病理特点分析，肿瘤有明确定义，以前也做为非典型性息肉样腺肌瘤(APA)。 Patients ranged in age from 25 to 73 (mean, 39.9) years. 患者年龄从25－73，中位年龄为39、9岁.All but two of the patients were premenopausal, and 14 were undergoing evaluation for infertility.除两例外，其它患者都是生育期妇女，14例有不孕症。 Histologically, the lesions featured a biphasic proliferation of architecturally complex and cytologically atypical endometrial glands within a myofibromatous stroma. widely separated and loosely clustered irregular but branched glands embedded in broad zones of cellular myofibromatous stroma to those possessing crowded, markedly complex, branching glands separated by sparse intersecting fascicles of fibromuscular tissue. 显微镜下的特点是双相增生，两种成份，子宫内膜腺体和细胞呈非典型性增生，还有子宫肌瘤样间质成份，子宫肌瘤样间质成份弥漫分隔松散的，成片状排列，但不规则的分技状子宫内膜样腺体，这些腺体也可以呈拥挤的，明显复杂性增生。子宫肌瘤样间质使其腺体包埋在宽阔的富于细胞性子宫肌瘤性间质中。The stroma in all cases was actin or desmin positive or both.这些间质成份actin阳或desmin阳，或者双阳。 Morular/squamous metaplasia was present in all but two cases and florid in most. 53例出现了鳞化细胞团（槡堪样细胞团），两例没有见到，55例患者多数都同时拥有子宫平滑肌瘤。All cases exhibited architecturally complex glands, and in 25 cases the architectural complexity was indistinguishable from that of well-differentiated endometrial adenocarcinoma, as we have defined it; that is, they had a high architectural index.55例都有结构复杂的腺体成份，25例患者结构太复杂，很难与高分化子宫内膜样腺癌区别，因此我们认为该病有非常高的复杂指数。 Twenty-nine patients were initially treated with polypectomy or curettage followed by hormonal therapy 29例患者最初用单纯息肉样肿物切除或刮宫治疗，然后用激素治疗随访; persistent or recurrent APA developed in 45% of the patients in this group (33% with low architectural index vs. 60% with high architectural index).这29例中有45%的患者肿瘤复发或症状持续，该组中有33%是低复杂指数，60%是高复杂指数。 Five patients had successful pregnancies despite persistent disease.5例患者成功怀孕，尽管患者有症状持续着。 Superficial myoinvasion was identified in the hysterectomy specimen in two of 12 APAs with a high architectural index but not in 21 APAs with a low architectural index. 做子宫切除的12例患者，有高复杂结构指数，其中两例有子宫肌浅表浸及，另21例低复杂结构指数的患者切除子宫，没有一例浸及肌层。All patients are alive and well 1 to 112 months after diagnosis (mean, 25.2 months). 我们随访1－112个月，平均随访25、2个月，55例患者均健在，On the basis of this study, we propose that APAs with markedly complex glands (high architectural index) be designated "atypical polypoid adenomyofibromas of low malignant potential" (APA-LMP) to emphasize the potential risk for myometrial invasion. 根据我们的研究显示，子宫非典型性息肉样肌腺瘤有复杂性腺体成份，有高复杂结构指数，被认定是低恶性潜能，强调有潜在浸及子宫肌能力。A treatment program featuring local excision accompanied by close follow-up is warranted for APA despite the presence of recurrent or persistent disease.治疗应该是局部切除，密切随访，尽管有复发或症状持续， Patients with APA-LMP may also, in selected cases, be managed with less than hysterectomy, although (as with the usual well-differentiated carcinoma) there is a small but definite risk associated with this approach我们很少做子宫切除，有非常少伴有高分化癌的可能，但是也有可以有这样的危险。
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本帖最后由 于 2009-03-08 10:33:00 编辑
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Atypical polypoid adenomyofibromas (atypical polypoid adenomyomas) of the uterus. A clinicopathologic study of 55 cases.
Division of Surgical Pathology, Stanford University Medical Center, CA 94305, USA.
We present the clinicopathological and immunohistochemical features of 55 atypical polypoid adenomyofibromas, a definitional expansion of an entity previously reported as "atypical polypoid adenomyoma" (APA) of the uterus. Patients ranged in age from 25 to 73 (mean, 39.9) years. All but two of the patients were premenopausal, and 14 were undergoing evaluation for infertility. Histologically, the lesions featured a biphasic proliferation of architecturally complex and cytologically atypical endometrial glands within a myofibromatous stroma. The histologic pattern ranged from widely separated and loosely clustered irregular but branched glands embedded in broad zones of cellular myofibromatous stroma to those possessing crowded, markedly complex, branching glands separated by sparse intersecting fascicles of fibromuscular tissue. The stroma in all cases was actin or desmin positive or both. Morular/squamous metaplasia was present in all but two cases and florid in most. All cases exhibited architecturally complex glands, and in 25 cases the architectural complexity was indistinguishable from that of well-differentiated endometrial adenocarcinoma, as we have defined it; that is, they had a high architectural index. Twenty-nine patients were initially treated with polypectomy or curettage followed by hormonal therapy; persistent or recurrent APA developed in 45% of the patients in this group (33% with low architectural index vs. 60% with high architectural index). Five patients had successful pregnancies despite persistent disease. Superficial myoinvasion was identified in the hysterectomy specimen in two of 12 APAs with a high architectural index but not in 21 APAs with a low architectural index. All patients are alive and well 1 to 112 months after diagnosis (mean, 25.2 months). On the basis of this study, we propose that APAs with markedly complex glands (high architectural index) be designated "atypical polypoid adenomyofibromas of low malignant potential" (APA-LMP) to emphasize the potential risk for myometrial invasion. A treatment program featuring local excision accompanied by close follow-up is warranted for APA despite the presence of recurrent or persistent disease. Patients with APA-LMP may also, in selected cases, be managed with less than hysterectomy, although (as with the usual well-differentiated carcinoma) there is a small but definite risk associated with this approach
A good paper about APA from Stanford more than 10 years ago
Am J Surg Pathol. 1996 Jan;20(1):1-20.
