子宮內(nèi)膜去分化癌6例臨床病理特點(diǎn)

于秋萍　張觀宇　齊亞飛

[關(guān)鍵詞] 子宮內(nèi)膜;去分化癌;癌肉瘤;未分化癌

[中圖分類號(hào)] R737.33? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] B? ? ? ? ? [文章編號(hào)] 1673-9701（2021）22-0144-04

Clinicopathological characteristics of 6 cases of dedifferentiated endometrial carcinoma

YU Qiuping1? ?ZHANG Guanyu2? ?QI Yafei3

1.Department of Pathology， Shenyang 245 Hospital， Shenyang? ?110042， China; 2.Department of Pathology， Liaoyang Liaohua Hospital in Liaoning Province， Liaoyang? ?111003， China; 3.Department of Pathology， Shengjing Hospital Affiliated to China Medical University， Shenyang? ?110004， China

[Abstract] Objective To investigate the clinical characteristics， histopathology and immunophenotype characteristics of dedifferentiated endometrial carcinoma， to conduct a comprehensive analysis of its diagnosis and differential diagnosis， and to deepen the understanding of the disease. Methods Six cases of dedifferentiated endometrial carcinoma from the Department of Pathology in the 245 Hospital of Shenyang and Shengjing Hospital Affiliated to China Medical University from January 2015 to June 2020 were retrospectively analyzed. The clinicopathological characteristics were observed， and the relevant literature was reviewed. Results The average age of the six patients with dedifferentiated endometrial carcinoma was （59.83±5.15） years old. Two tumor cell morphologies were observed under the microscope， one of which was a low-grade endometrioid adenocarcinoma， and the other was an undifferentiated round and oval cells that resemble sarcoma-like morphology. Immunohistochemical staining showed that the undifferentiated areas were all vimentin（+）， ER， PR all（-）， epithelial markers CK（pan）， EMA focally weak（+）， CD56 and Syn local（+）， and 5 cases of P53 were wild type， 1 case was（-， nonsense mutation）; low-grade endometrioid carcinoma areas were all vimentin（+）， ER， PR（+）， CK（+）， 4 cases of microsatellite instability， and MLH1 and MSH2 negative. Conclusion Endometrial dedifferentiated carcinoma is a rare type of primary malignant epithelial tumor of the uterus. It has special clinicopathological histomorphological characteristics. Deepening the understanding of the disease can improve the accuracy of pathological diagnosis and guide clinical treatment.

[Key words] Endometrial; Dedifferentiated carcinoma; Carcinosarcoma; Undifferentiated carcinoma

子宮內(nèi)膜去分化癌（Dediffrentiated endometrial adenocarcinoma，DEAC）是子宮內(nèi)膜癌中一種罕見(jiàn)類型， 惡性度高、預(yù)后差、死亡率高[1]。其是同時(shí)存在高-中分化內(nèi)膜樣癌和未分化癌兩種成分的癌[2]，該腫瘤的預(yù)后較高級(jí)別內(nèi)膜樣癌更差[3]，有研究顯示，其常伴有高水平微衛(wèi)星不穩(wěn)定性[4]。生物學(xué)行為主要取決于未分化癌所占比例，未分化癌成分所占比例越多，預(yù)后越差[5]。DEAC在WHO（2014版）女性生殖器官腫瘤分類中已正式命名為子宮內(nèi)膜癌的獨(dú)立類型[6]。本研究收集6例2015年1月至2020年6月沈陽(yáng)二四五醫(yī)院和中國(guó)醫(yī)科大學(xué)附屬盛京醫(yī)院病理科的DEAC，通過(guò)分析DEAC的臨床病理特征、免疫組化標(biāo)記結(jié)果，探討MLH1和MSH2在子宮內(nèi)膜去分化癌表達(dá)的意義，并復(fù)習(xí)相關(guān)文獻(xiàn)，結(jié)合其臨床病理特點(diǎn)、鑒別診斷及預(yù)后，提高對(duì)該病的認(rèn)識(shí)，現(xiàn)報(bào)道如下。