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43岁女性，反复阴道流血3月余，盆腔MRI示子宫腔、子宫下段及子宫肌层多个肿块，子宫下段最大，直径约7.5cm，临床行次广泛子宫+双附件切除。巨检：子宫腔、子宫下段及子宫肌层多个肿块，子宫下段肿物约7.5×6.8×6cm，宫腔内肿物呈结节状，充满宫腔，子宫肌层见多个结节，直径1.2-1.8cm，肿物切面灰白色，质的细腻，鱼肉样。双附件未见明确异常。

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本帖最后由 xinzhu1492 于 2013-01-05 19:31:56 编辑

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18 楼发表于2013-01-07 16:29:51举报|引用
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根据病变部位好发肿瘤及HE形态，肿瘤组织内血管丰富，毛细血管、静脉以及类似子宫内膜的螺旋动脉样的血管，肿瘤组织排列似血管外皮瘤样，少部分区域内有上皮或上皮样分化，肿瘤沿扩张的血管生长，呈舌状浸润周围平滑肌组织，瘤组织内含玻璃样变的胶原纤维带；以上特点支持子宫内膜间质肉瘤，有低级别区，也有少部分未分化子宫肉瘤区。补作免疫组化CD10散在（+）（低级别子宫内膜间质肉瘤区域），但为何S-100（+）？文献并未提及S-100的阳性问题！

Diagnostic immunohistochemistry in uterine sarcomas: a study of 397 cases.

Int J Gynecol Pathol. 2011 May;30(3):236-43.

Abeler VM, Nenodovic M.

Abstract

The purpose of this study was to evaluate the use of a broad panel of antibodies used as diagnostic markers for abdominal mesenchymal tumors in uterine sarcomas. The expression of vimentin, AE1/AE3, smooth muscle actin (SMA), desmin , h-caldesmon, actin, Myf4, CD10, CD31, CD68, CD117, factor VIII, HMB-45, and S-100 protein was studied in 397 uterine sarcomas. SMA was positive in 90% of the ordinary leiomyosarcomas and when combined with desmin or h-caldesmon, a positivity of 96% and 92%, respectively, was achieved. Actin and Myf4 were positive in 4 of 5 rhabdomyosarcomas. Endometrial stromal sarcomas reacted positive with CD10 in 62 of 84 tumors and negative with h-caldesmon in 75 of 84 tumors. CD10 was the most frequent positive marker in adenosarcoma. Most tumor markers stained negative in undifferentiated uterine sarcoma, but 12 of 21 tumors reacted positive for SMA. A few focally HMB-45-positive cells were found within all tumor groups, except in rhabdomyosarcomas and giant cell tumors. Endothelial markers, S-100 protein, and CD117 do not seem to be of any diagnostic value in uterine sarcomas. In conclusion, when immunohistochemistry is used diagnostically in uterine sarcomas, a broad panel of markers provides better information than reliance on a single antibody.

根据病变部位好发肿瘤及HE形态，肿瘤组织内血管丰富，毛细血管、静脉以及类似子宫内膜的螺旋动脉样的血管，肿瘤组织排列似血管外皮瘤样，少部分区域内有上皮或上皮样分化，肿瘤沿扩张的血管生长，呈舌状浸润周围平滑肌组织，瘤组织内含玻璃样变的胶原纤维带；以上特点支持子宫内膜间质肉瘤，有低级别区，也有少部分未分化子宫肉瘤区。补作免疫组化CD10散在（+）（低级别子宫内膜间质肉瘤区域），但为何S-100（+）？文献并未提及S-100的阳性问题！

Diagnostic immunohistochemistry in uterine sarcomas: a study of 397 cases.

Int J Gynecol Pathol. 2011 May;30(3):236-43.

Abeler VM, Nenodovic M.

Abstract

The purpose of this study was to evaluate the use of a broad panel of antibodies used as diagnostic markers for abdominal mesenchymal tumors in uterine sarcomas. The expression of vimentin, AE1/AE3, smooth muscle actin (SMA), desmin , h-caldesmon, actin, Myf4, CD10, CD31, CD68, CD117, factor VIII, HMB-45, and S-100 protein was studied in 397 uterine sarcomas. SMA was positive in 90% of the ordinary leiomyosarcomas and when combined with desmin or h-caldesmon, a positivity of 96% and 92%, respectively, was achieved. Actin and Myf4 were positive in 4 of 5 rhabdomyosarcomas. Endometrial stromal sarcomas reacted positive with CD10 in 62 of 84 tumors and negative with h-caldesmon in 75 of 84 tumors. CD10 was the most frequent positive marker in adenosarcoma. Most tumor markers stained negative in undifferentiated uterine sarcoma, but 12 of 21 tumors reacted positive for SMA. A few focally HMB-45-positive cells were found within all tumor groups, except in rhabdomyosarcomas and giant cell tumors. Endothelial markers, S-100 protein, and CD117 do not seem to be of any diagnostic value in uterine sarcomas. In conclusion, when immunohistochemistry is used diagnostically in uterine sarcomas, a broad panel of markers provides better information than reliance on a single antibody.