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目的探讨子宫肌壁间小叶样分割性平滑肌瘤(CDL)的临床病理学特征、诊断与鉴别诊断及预后。方法对5例子宫肌壁间小叶样分割性平滑肌瘤病例的临床表现、病理学、免疫组化特征进行回顾性分析并复习相关文献。结果 5例患者均因阴道异常出血和/或盆腔包块就诊,年龄平均44.8岁。大体表现为肌壁间结节状肿物分界不清,质地较软。镜下肿瘤性平滑肌细胞束形成大小不等的微结节状,边缘可以呈“舌状”或“指状”突起伸入正常平滑肌组织中,表现为“分割样”形态。免疫组化:SMA、actin和PR均(+),ER(+)/弱(+),CD10、HMB45、CD34和CD117均(-),Ki-67阳性指数低。随访17~61个月,均未发现肿瘤复发和转移。结论子宫肌壁间小叶样分割性平滑肌瘤是一种罕见的子宫肿瘤,好发于生育晚期及围绝经期女性,预后良好。分隔样生长方式是重要的病理特点,免疫组化有助于鉴别诊断,手术是有效的治疗手段。
Objective To investigate the clinicopathological features, diagnosis, differential diagnosis and prognosis of uterine mitral leaflet-like segmental leiomyomata (CDL). Methods The clinical manifestations, pathological features and immunohistochemical features of 5 cases of uterine myenteric mitral leaflet-like leiomyoma were analyzed retrospectively and the related literatures were reviewed. Results All 5 patients were treated by abnormal vaginal bleeding and / or pelvic masses, with an average age of 44.8 years. Generally manifested as intramural nodular tumor unclear boundaries, texture is soft. Microscopically, the tumorous smooth muscle cells formed micro-nodules of varying sizes and the edges could be “tongue-like” or “finger-like” protrusions extending into normal smooth muscle tissue with “split-like” morphology . Immunohistochemistry showed that there was a low Ki-67 positive index in both SMA, actin and PR (+), ER (+) / weak (+), CD10, HMB45, CD34 and CD117. Follow-up 17 to 61 months, no recurrence and metastasis were found. Conclusion The uterine mitral lobe-like disseminated leiomyoma is a rare uterine tumor, which occurs predominantly in the late stage of childbirth and perimenopausal women and has a good prognosis. Isolated growth patterns are important pathological features, immunohistochemistry contribute to the differential diagnosis, surgery is an effective treatment.