子宫内膜去分化癌6例临床病理特点

于秋萍　张观宇　齐亚飞

[关键词] 子宫内膜;去分化癌;癌肉瘤;未分化癌

[中图分类号] R737.33          [文献标识码] B          [文章编号] 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

子宫内膜去分化癌（Dediffrentiated endometrial adenocarcinoma，DEAC）是子宫内膜癌中一种罕见类型， 恶性度高、预后差、死亡率高[1]。其是同时存在高-中分化内膜样癌和未分化癌两种成分的癌[2]，该肿瘤的预后较高级别内膜样癌更差[3]，有研究显示，其常伴有高水平微卫星不稳定性[4]。生物学行为主要取决于未分化癌所占比例，未分化癌成分所占比例越多，预后越差[5]。DEAC在WHO（2014版）女性生殖器官肿瘤分类中已正式命名为子宫内膜癌的独立类型[6]。本研究收集6例2015年1月至2020年6月沈陽二四五医院和中国医科大学附属盛京医院病理科的DEAC，通过分析DEAC的临床病理特征、免疫组化标记结果，探讨MLH1和MSH2在子宫内膜去分化癌表达的意义，并复习相关文献，结合其临床病理特点、鉴别诊断及预后，提高对该病的认识，现报道如下。