女62岁，G3P3，绝经后少量出血数天。Prempro治疗反应好。内膜活检示子宫内膜增生。超声示宫壁增厚，一个肌瘤直径7cm。行子宫切除术。

子宫大小：7*7*6.5cm，重207g。宫壁内一个4.5*5.5cm的界清肿块，切面均质，灰白灰红色，质软，鱼肉样，无坏死和出血。（abin译）

从图像看还是象颗粒细胞瘤，期待免疫组化

  有趣的病例! 图片上看类似卵巢颗粒细胞瘤，不知卵巢是否有病变？

  如果病变仅在子宫则考虑类似卵巢性索肿瘤的子宫内膜间质肿瘤（Endometrial stromal tumor resembling ovarian sex-cord tumor）。子宫内膜间质肿瘤可出现可为局灶或广泛的卵巢性索-间质肿瘤的分化，在子宫内膜间质结节和低级别子宫内膜间质肉瘤都可出现，性索分化可能不影响肿瘤的预后。

HE：组织学似子宫内膜间质肿瘤。

IHC：肌源性表型。

诊断：

平滑肌肿瘤？（富细胞性？恶性潜能未定？）

核分裂多少？

Dear Zenggang,

I hope this note finds you well. I have not heard from you since our Colorado meet at USCAP meeting. I am sure I will see you next year in Boston. Thank you for sharing this fantastic case. Based on classic gross picture, morphology and immunoreactive profile, I am concerned about " Uterine Tumor resembling ovarian sex cord tumor (UTROSCT). Of course the differential is always ESTSCLE ( Endometrial stromal tumor with sex cord-like elements). Based on CD10 negativity, I favor the former, since 9 out of 10 ESS (endometrial stromal tumor) will be positive for CD10. Sometimes you can see focal CD10 positivity in typical UTROSCT cases. I would like to know if you have chance to run calretinin, CD99 and Melan A on this case.

For starter, I want to caution you to make UTROSCT diagnosis base on EM biopsy or curretting since so much overlapping features between ESS and UTROSCT. Clinically UTROSCT has much better prognosis than ESS. Whenever you deal with a dilemma like this case, you always think to order Calretinin, CD99 and Melan A.

Thanks again for sharing and I am looking forward for your final answer.

Bin

 这例比较迷惑。等待学习。

大体：似子宫内膜间质结节/肉瘤，或平滑肌肿瘤（多个腔隙/裂隙--静脉内平滑肌瘤病？）。

HE：组织学似卵巢的粒层细胞瘤。

IHC：肌源性表型（平滑肌表型？建议加做h-caldesmon）。

诊断：

平滑肌肿瘤？（伴性索样分化？富细胞性？恶性潜能未定？）