在阅片过程中，如果息肉呈分叶状，类似乳腺叶状肿瘤，就要谨慎，如间质细胞分层，向靠近上皮处聚集密集，有些异型性，核分裂，就要考虑腺肉瘤的可能。

 苗勒氏腺，游离面具有纤毛。胞浆如同浆液性上皮的染色。

 低度恶性苗勒氏腺肉瘤

 轻=中度异型的间质细胞呈多层不等地密集围绕在苗勒腺周围，而这之外的间质却如同良性的息肉样间质。

 

    

 这些围绕苗勒腺排列的异型间质细胞可见病理性核分裂（三极核分裂，请见异型间质细胞区中段靠近中央处）。

接下来就是用哪些指标来诊断与鉴别诊断。

 苗勒氏腺肉瘤

 苗勒氏腺肉瘤-学习了，谢谢！

 低度恶性苗勒氏腺肉瘤。

与宫颈叶状肿瘤怎样鉴别？

 低度恶性苗勒氏腺肉瘤

 苗勒氏腺肉瘤

关于子宫低度恶性苗勒氏腺肉瘤的诊断问题：

1.不常见，见于15-90岁任何年龄，常见于绝经后妇女，有些病例是乳腺癌后与它莫昔芬治疗有关。病人典型症状是不规则阴道流血。该肿瘤起初可能被误诊为内膜息肉，直到对其复发病变再次切除时才考虑到腺肉瘤的诊断。
 Uterine adenofibrosarcoma is an unconmon neoplasm,which occurs in women of all ages ranging from 15-90 years,but often in postmenopausal women.Some cases have been associated with tamoxifen therapy for breast cancers.The typical symptoms of the patients are abnormal vaginal bleeding.The tumors may not correctly diagnosed as adenosarcoma until re-exicision of a recurrent polypoid lesion.
2.肿块常呈外生性息肉样，通常为单发，有的呈多发性乳头状肿块,大的肿块可从宫腔伸向阴道。切面可见有扩张的小囊，肿瘤可见有小灶出血和坏死。
 The neoplasms typically grow as exophtic polypoid masses which present usually as a single,sometimes as multiple papillary masses.The largest masses may extend to the vagina from the uterine cavity.On sectioning, they contain dilated small cysts,with foci of haemorrhage and necrosis.
3.该肿瘤属于上皮与间质混合性肿瘤，由良性腺上皮及其围绕腺周的肉瘤样间质成分构成。低倍镜下见分叶状结构，看似乳腺叶状肿瘤。
 They are mixed epithelial and mesenchymal components and composed of benigin epithelialand sarcomatoid mesenchymal components surrounding the glands.Under low magnification,a leaf-like pattern closely resembling phyllodes tumor of the breast is obserbed.
4.其上皮成分可以是内膜样型或是纤毛型(苗勒mullerian型），呈立方状或是柱状不定。本例属于苗勒型，无异型性。
 The epithelial component may be endometrioid or ciliated in type(mullerian type),but often is non-descript cuboidal or columnar.This cace presents as typically mullerian type.
5.肉瘤样间质呈袖套状围绕在腺周，富于细胞。核分裂的评价要在富于细胞的袖套状区域来计数，一般来说，核分裂计数要大于1个/每10HPH（高倍视野下）。这些肿瘤细胞的异型性为轻度异型，偶有见中度异型性，或者说是间质细胞呈轻-中度异型。
 Sarcomatoid mesenchyme,marked stromal hypercellularity,present as a pattern with periglandular cuffing.Their mitotic figures,usually stated to be more one per 10 high power fields,are reguired in the hypercellular cuffing.Cytological atypia is typically only mild,but occasionall moderate（more than mild stromal atypia).
6.免疫标记：上皮CK无疑。异型间质细胞可灶性表达CD10，Vimentin阳性，P53可阳性。不同程度表达平滑肌性标志物。
 Immunoprofile:The epithelial components reacts undoubtedly with cytokeratins.The mesenchymal component usually reacts with vimentin ,p53 and focally with antibodies to CD10.Veriable degretes of staining for smooth mulcle markers can be observed.
 

 HE图片：
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 很像乳腺的叶状肿瘤，间质有问题，腺上皮还好。是不是腺肉瘤？

 诊断与鉴别诊断：

1）宫腔-宫颈管-阴道息肉或腺纤维瘤

2）非典型苗勒氏腺纤维瘤

3）低度恶性苗勒氏腺肉瘤

4）非典型性腺肌瘤

5）宫颈叶状肿瘤