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盆腔少见肿瘤

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楼主 发表于 2010-01-21 14:40|举报|关注(0)
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姓    名: ××× 性别: 女性  年龄: 44 
标本名称:  盆腔肿瘤
简要病史:  
肉眼检查:  

患者女性,44岁。

病史:全子宫及左侧附件切除术后1年余,发现盆腔肿瘤3天。

   1年前因子宫内膜癌行全子宫切除。现行B超示:盆腔内见10.5X9.3CM的不过则实性低回声包块,边界清,其内见丰富血流信号,右下腹可见2CM的液性暗区。MRI:子宫缺如,膀胱壁光滑,膀胱右上方见11X7X9CM的团块状回声,盆腔未见肿大淋巴结,盆腔少量积液,考虑肿瘤复发。

  肉眼检查见:块状组织一堆,大小13X115CM,其中最大块大小为5X4X3CM,表面较光滑,切面灰黄色质软,呈胶冻状有粘液感,其余组织切面灰黄色质脆,中心可见灰白色软骨结节。

   免疫组化:CD34多形细胞区及梭形细胞区(+)ERPR梭形细胞区及小细胞区(+),SMA多形细胞区及梭形细胞区(-),S-100梭形细胞区及小细胞区(-),Desmin梭形细胞区及小细胞区(+),DOG1梭形细胞区(-),CD10梭形细胞区及小细胞区(+),CD117梭形细胞区(+)及多形细胞区(-)。

  镜下大致分为4个区域:多形细胞区域,梭形细胞区域,软骨区域及小细胞区域。

  下图为多形细胞区域

  • 盆腔少见肿瘤图1
    图1
  • 盆腔少见肿瘤图2
    图2
  • 盆腔少见肿瘤图3
    图3
  • 盆腔少见肿瘤图4
    图4
  • 盆腔少见肿瘤图5
    图5
  • 盆腔少见肿瘤图6
    图6
  • 盆腔少见肿瘤图7
    图7
  • 盆腔少见肿瘤图8
    图8
  • 盆腔少见肿瘤图9
    图9
  • 盆腔少见肿瘤图10
    图10
  • 盆腔少见肿瘤图11
    图11
  • 盆腔少见肿瘤图12
    图12
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本帖最后由 于 2010-01-21 14:45:00 编辑
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高度恶性苗勒氏管肉瘤

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21 楼    发表于2010-01-27 20:55:00举报|引用
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本例就诊断而言:未分化肉瘤倾向苗勒氏管......(部分ER PR+、Desmin+、CD10+、支持)可以了。关键是PR与CD117部分阳性,对治疗和预后有帮助。

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22 楼    发表于2010-01-28 03:16:00举报|引用
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 Interesting case.

Most importance is to stain several CK markers such as AE1/AE3 and Cam 5.2 to make sure if epithelial component is present in term of the name of the diatgnosis.

1. Clearly it is malignant tumor of mullerian origian (ER/PR+) and the location.

2. If cam 5.2 scattered positive, it is MMMT

3. If no any ck positive and no any glanular component, it is a high grade mullerian sarcoma .

4. Andeosarcoma is the most common among these lesions above. If you submit more sections and can see some even a few benign glands, it is a mullerian adenosarcoma with stromal over growth and cartilage differentiaton.

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23 楼    发表于2010-01-28 03:43:00举报|引用
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Am J Surg Pathol. 2009 Feb;33(2):278-88.

Mullerian adenosarcoma: a clinicopathologic and immunohistochemical study of 55 cases challenging the existence of adenofibroma.

Gallardo A, Prat J.

Department of Pathology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.

Mullerian adenosarcomas are rare mixed tumors of low malignant potential that occur mainly in the uterus and also in extrauterine locations. Microscopically, they may be difficult to distinguish from adenofibromas. In this clinicopathologic study of 55 adenosarcomas, the mean patient age was 50 years (range: 13 to 83 y). Thirty-seven tumors were of the uterine corpus, 11 of the cervix, 4 of the ovary, and 1 each of the fallopian tube, vagina, and Douglas peritoneum. Abdominal pain and vaginal bleeding were the usual complaints. Treatment was known in 50 patients: 10 had polypectomy, 1 cone biopsy, and 39 hysterectomy, which was accompanied by bilateral salpingo-oophorectomy in 24 and lymphadenectomy in 4. Five patients had radiotherapy and 2 of them had chemotherapy. Stage was known in 41 cases. Of 30 tumors of the uterine corpus, 17 were stage IA, 11 stage IB, 1 stage IC, and 1 stage IIIC. Four cervical tumors were stage IB. Three of the 4 ovarian tumors were stage IA and the other was stage IIIC. The tumor of the fallopian tube was stage IC, and the tumors of the vagina and recto-uterine pouch were confined to their site of origin. Most uterine tumors were polypoid masses ranging from 1 to 20 cm (mean: 6.5 cm). Microscopically, sarcomatous overgrowth was found in 18 cases (33%), heterologous elements in 13 (24%), and sex cordlike differentiation in 7 (13%). Fourteen of 30 uterine tumors (47%) had myometrial invasion that was minimal in 5, involved one-third of the myometrial thickness in 7, and more than 50% in 2. Of 4 cervical tumors, 2 were endocervical polyps, 1 invaded one-third of the cervical wall, and the other invaded its full thickness. Follow-up information (2 mo to 18 y; average: 7.5 y) was available in 29 patients. Six developed metastases and 5 of them died of tumor. Four had adenosarcomas with sarcomatous overgrowth; however, the other 2 patients had typical low-grade adenosarcomas of the uterine corpus and cervix, respectively, exhibiting only mild nuclear atypia of the stromal component and </=2 mitotic figures/10 high power fields. Both were initially underdiagnosed as adenofibromas. The finding of such cases, which raises the controversy of whether or not adenofibroma exists as a tumor entity, prompted us to make a comparative immunohistochemical analysis of 23 typical adenosarcomas, 8 adenosarcomas with sarcomatous overgrowth, and 29 benign and malignant related lesions, including 7 clinically benign adenofibromas. Adenosarcomas with sarcomatous overgrowth showed strong immunoreaction for Ki-67 and p53 and loss of CD10 and progesterone receptors immunostaining; in contrast, the immunoreaction for these tumor markers in typical adenosarcomas without sarcomatous overgrowth was similar to that of adenofibromas associated with favorable outcome and other benign lesions such as endometrial polyps and endometriosis. These findings suggest that some of the tumors currently classified as adenofibromas, on the basis of their low mitotic count and lack of significant nuclear atypia, are, in fact, well-differentiated adenosarcomas.

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如风如雪 离线

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24 楼    发表于2010-01-28 12:16:00举报|引用
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 本例再一次取材(取12块),未发现任何上皮成份,又加做了IHC:AE1/AE3-,CK7-,CK20-,没有做 cam 5.2和CA125。
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25 楼    发表于2010-01-28 15:03:00举报|引用
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以下是引用cqzhao在2010-1-28 3:16:00的发言:

 Interesting case.

Most importance is to stain several CK markers such as AE1/AE3 and Cam 5.2 to make sure if epithelial component is present in term of the name of the diatgnosis.

1. Clearly it is malignant tumor of mullerian origian (ER/PR+) and the location.

2. If cam 5.2 scattered positive, it is MMMT

3. If no any ck positive and no any glanular component, it is a high grade mullerian sarcoma .

4. Andeosarcoma is the most common among these lesions above. If you submit more sections and can see some even a few benign glands, it is a mullerian adenosarcoma with stromal over growth and cartilage differentiaton.

根据Dr. Zhao 的意见,可诊断为高度恶性苗勒氏管肉瘤。
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26 楼    发表于2010-01-28 15:06:00举报|引用
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本帖最后由 于 2010-01-28 15:13:00 编辑

Dr.Zhao 最后病理诊断:高度恶性苗勒氏管肉瘤。

 

感谢 Dr.如风如雪!

感谢 Dr. Zhao!

感谢 所有参与讨论的病理医生!

 

 

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27 楼    发表于2010-01-31 20:31:00举报|引用
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 高度恶性苗勒氏管肉瘤
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hyp 离线

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28 楼    发表于2010-01-31 22:58:00举报|引用
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 形态和免疫组化支持未分化子宫内膜肉瘤伴有软骨化生。一年前的子宫内膜图示:子宫内膜复杂性增生,最后一张切片提示子宫内膜间质肿瘤。建议复查患者一年前的切片有无明确的子宫内膜间质肿瘤和子宫内膜异位,有可能一年前已存在低级别子宫内膜间质肿瘤,现为在此基础上的复发,或在内膜异位的基础上也可发生间质肿瘤。
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29 楼    发表于2010-02-01 01:39:00举报|引用
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 子宫内膜间质肉瘤细胞具向有上皮、平滑肌、纤维母细胞分化潜能并具有相应的免疫表型。一般认为分化好的细胞多可同时表达CD10、ER、PR等,分化差的细胞常不表达激素受体等。本例形态显示:小细胞和梭形细胞区核分裂象少见,细胞较一致,可以看到丰富的螺旋动脉样小动脉和围绕小动脉呈旋涡状排列的小梭形和卵圆形细胞,可以看到泡沫细胞和出血(后三张图),符合低级别子宫内膜间质肉瘤。多形性细胞区细胞异型性显著,核分裂象多见,倾向未分化子宫内膜肉瘤。其不同的细胞形态反映了同一肿瘤不同的分化程度。小细胞和梭形细胞区表达ER、PR、CD10等抗体,而多形性细胞区不表达ER等,显示免疫组化结果也是支持的。软骨是异源性化生。综上所述认为是子宫内膜间质肉瘤伴有软骨化生。
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