【摘要】 目的探讨子宫峡部内膜腺癌(uterine isthmic endometrial adenocarcinoma,UIE)的临床病理特征、生物学行为及预后。方法回顾性分析14例UIE临床病理资料,总结其大体、组织学、免疫组化及预后特点,并与63例子宫体内膜腺癌(uterine cor-pus endometrial adenocarcinoma,UCE)相比较。结果UIE病灶中心在子宫峡部,仅有局部宫颈上端及宫体下端的蔓延。子宫峡部肿块呈外生性息肉状或内生浸润性生长,直径1.5～4cm;9例(64.3%)UIE浸润深肌层(>50%),其中4例浸润达浆膜。组织学上,1例为透明细胞型,2例为鳞腺癌,11例为子宫内膜样型;11例(78.6%)UIE为高级别(7例G2、4例G3)。UIE患者的临床分期,I期1例(7.1%),Ⅱ期8例(57.2%)、Ⅲ期4例(28.6%)及Ⅳ期1例(7.1%)。UIE与UCE在浸润深肌层、组织级别、临床分期及淋巴管浸润上差异有显著性;而ER、PR及p53的表达在UIE与UCE之间差异无显著性。结论子宫峡部内膜腺癌是少见的,临床病理及生物学行为与UCE不同。UIE是独立的预后差的子宫内膜腺癌。更多还原

【Abstract】 Purpose To investigate the clinicopathological features of uterine isthmic endometrial adenocarcinoma (UIE) and its behavior and prognosis. Methods 14 cases of UIE were retrospectively analyzed and compared with 63 cases of the uterine corpus endometrial adenocarcinoma (UCE) with respect to clinical information and pathological changes. Results The tumor was centered in the isthmus and involved only focal extension into the upper endocervix and lower uterine corpus. Gross examination of UIE revealed exophytic polypoid or intrinsic invasive masses that measured 1.5 to 4cm in diameter. Nine (64.3%) of the UIE patients had >50% myometrial invasion and extended to the uterine serosa in four cases. The histological subtypes were clear cell carcinoma (n=1), adenosquamous carcinoma (n=2) and endometrioid adenocarcinoma (n=11). Eleven (78.6%) of the UIE patients were grade 2 or grade 3 (G2 in 7, G3 in 4). One (7.1%) of the UIE patients had stage Ⅰ, eight (57.2%) stage Ⅱ, four ((28.6%) stage Ⅲ and one (7.1%) stage Ⅳ. The UIE patients had a significantly higher frequency (>50%) of myometrial invasion, histological grade, surgical stage, and lymphovascular invasion compared with UCE patients. No significant difference was seen in the expression of ER, PR and p53 between UIE and UCE patients.Conclusions UIE is rare and different from UCE in clinicopathogical features and behaviors. UIE should be considered as a unique form of uterine endometrial adenocarcinoma with poor prognosis.更多还原