子宫外子宫内膜间质肉瘤临床特点及与内异症关系的临床研究
发布时间：2018-09-18 21:45
【摘要】：研究背景 子宫内膜异位症在组织学上是一种良性疾病,但却有局部浸润、远处转移等恶性生物学行为的表现,并且内异症组织可发生恶变。内异症恶变相关肿瘤包括多种病理类型,最常见的是腺癌(70%)和肉瘤(12%),Higashiura等将内异症恶变相关肿瘤分为以下几种(1)卵巢上皮性肿瘤,以子宫内膜样癌、透明细胞癌为主；(2)其它苗勒氏管肿瘤；(3)肉瘤,以子宫内膜间质肉瘤、腺肉瘤为主。目前内异症病灶腺上皮细胞恶变与卵巢癌的关系方面已有较多的文献报道,内异症病灶子宫内膜间质细胞恶变与子宫肉瘤的关系的研究少见,它的临床特点、病理表现、预后因素尚不清楚。子宫内膜间质肉瘤可发生于子宫外组织,现有两种理论解释其成因,一是子宫内膜异位症组织恶变形成,另一是由盆腔间皮原始苗勒氏细胞恶变形成。研究子宫外子宫内膜间质肉瘤的临床病理特点、及其与子宫内膜异位症的关系,有助于加深对子宫外子宫内膜间质肉瘤来源、及其与子宫内膜异位症恶变的关系的理解。 研究目标 探索子宫外子宫内膜间质肉瘤的临床特点及其与子宫内膜异位症的关系。 方法 回顾性分析北京协和医院2002年12月至2012年12月期间接受手术的子宫内膜间质肉瘤患者的资料,(1)按照病变部位将其分为两组：子宫起源的子宫内膜间质肉瘤组和子宫外子宫内膜间质肉瘤组,比较两组的临床和病理特点,(2)根据是否合并子宫内膜异位症将子宫外子宫内膜间质肉瘤患者分为两组：合并内异症的子宫外子宫内膜间质肉瘤组和不合并内异症的子宫外子宫内膜间质肉瘤组,比较两组的临床和病理特点。 结果 与子宫起源的子宫内膜间质肉瘤相比,子宫外子宫内膜间质肉瘤有以下特点：(1)临床表现不同,盆腔包块占多数(45.5%,P=0.010),异常阴道流血少见；(2)术前血清CA125水平相当；(3)诊断时FIGO分期期别较晚(P.001)；(4)更易合并子宫内膜异位症(36.4%vs9.3%,P=0.031)；(5)病理亚型及免疫组织化学染色无明显区别。 子宫外子宫内膜间质肉瘤患者中,合并内异症组与不合并内异症组相比,两者在年龄、月经状态、术前CA125水平、病理分型、分期、免疫组化特点方面无明显区别,合并内异症组中CA125异常患者的比例可能更高。 结论 与子宫起源的子宫内膜间质肉瘤相比,子宫外子宫内膜间质肉瘤具有不同的临床特点,临床表现不同,合并内异症的比例较高,但其病理分型及免疫组化并无区别。提示子宫外子宫内膜间质肉瘤的起源可能与内异症密切相关。
[Abstract]:Background endometriosis is a benign disease histologically, but it has local invasion, distant metastasis and other malignant biological behavior. Malignant neoplasms associated with endometriosis include various pathological types, the most common ones are adenocarcinoma (70%) and sarcoma (12%) Higashiura, which can be classified into the following types: (1) epithelial ovarian neoplasms, mainly endometrial carcinoma and clear cell carcinoma; (2) other Mullerian duct tumors and (3) sarcoma, mainly endometrial stromal sarcoma and adenosarcoma. At present, there have been many reports on the relationship between adenoepithelial cell malignancy and ovarian cancer in endometriosis. The relationship between endometrial stromal cell malignancy and uterine sarcoma is rare, its clinical features and pathological manifestations are rare. Prognostic factors are unclear. Endometrial stromal sarcoma can occur in extrauterine tissue. There are two theories to explain its cause. One is the formation of malignant change in endometriosis and the other is the formation of the malignant transformation of primitive Myeles cells in the pelvis. To study the clinicopathological features of endometrial stromal sarcoma and its relationship with endometriosis is helpful to understand the origin of endometrial stromal sarcoma and its relationship with malignant change of endometriosis. Objective to explore the clinical features of endometrial stromal sarcoma and its relationship with endometriosis. Methods the data of patients with endometrial stromal sarcoma operated from December 2002 to December 2012 in Peking Union Hospital were retrospectively analyzed. (1) the patients were divided into two groups according to the location of the lesion: endometrium of uterine origin. Stromal sarcoma group and extrauterine endometrial stromal sarcoma group, The clinical and pathological features of the two groups were compared. (2) according to whether endometriosis was associated with endometrial stromal sarcoma, patients with endometrial stromal sarcoma were divided into two groups: ectopic endometrial stromal sarcoma group and non-endometriosis group. Of the extrauterine endometrial stromal sarcoma group, The clinical and pathological features of the two groups were compared. Results compared with endometrial stromal sarcoma of uterine origin, the extrauterine endometrial stromal sarcoma had the following characteristics: (1) the clinical manifestations were different, pelvic mass accounted for the majority (45.5%), abnormal vaginal bleeding was rare, (2) preoperative serum CA125 level was the same. (3) there was no significant difference in pathological subtypes and immunohistochemical staining between FIGO staging (P.001); (4) and endometriosis (36.4 vs 9.331); (5). There was no significant difference in age, menstrual status, preoperative CA125 level, pathological type, staging, and immunohistochemical features between patients with endometrium stromal sarcoma and those without endometriosarcoma. The proportion of patients with abnormal CA125 may be higher in patients with endometriosis. Conclusion compared with endometrial stromal sarcoma of uterine origin, extrauterine endometrial stromal sarcoma has different clinical features and different clinical manifestations, and the incidence of endometriosis is higher than that of endometrial stromal sarcoma. However, there was no difference between pathological classification and immunohistochemistry. These results suggest that the origin of endometrial stromal sarcoma may be closely related to endometriosis.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33
本文编号：2249174
[Abstract]:Background endometriosis is a benign disease histologically, but it has local invasion, distant metastasis and other malignant biological behavior. Malignant neoplasms associated with endometriosis include various pathological types, the most common ones are adenocarcinoma (70%) and sarcoma (12%) Higashiura, which can be classified into the following types: (1) epithelial ovarian neoplasms, mainly endometrial carcinoma and clear cell carcinoma; (2) other Mullerian duct tumors and (3) sarcoma, mainly endometrial stromal sarcoma and adenosarcoma. At present, there have been many reports on the relationship between adenoepithelial cell malignancy and ovarian cancer in endometriosis. The relationship between endometrial stromal cell malignancy and uterine sarcoma is rare, its clinical features and pathological manifestations are rare. Prognostic factors are unclear. Endometrial stromal sarcoma can occur in extrauterine tissue. There are two theories to explain its cause. One is the formation of malignant change in endometriosis and the other is the formation of the malignant transformation of primitive Myeles cells in the pelvis. To study the clinicopathological features of endometrial stromal sarcoma and its relationship with endometriosis is helpful to understand the origin of endometrial stromal sarcoma and its relationship with malignant change of endometriosis. Objective to explore the clinical features of endometrial stromal sarcoma and its relationship with endometriosis. Methods the data of patients with endometrial stromal sarcoma operated from December 2002 to December 2012 in Peking Union Hospital were retrospectively analyzed. (1) the patients were divided into two groups according to the location of the lesion: endometrium of uterine origin. Stromal sarcoma group and extrauterine endometrial stromal sarcoma group, The clinical and pathological features of the two groups were compared. (2) according to whether endometriosis was associated with endometrial stromal sarcoma, patients with endometrial stromal sarcoma were divided into two groups: ectopic endometrial stromal sarcoma group and non-endometriosis group. Of the extrauterine endometrial stromal sarcoma group, The clinical and pathological features of the two groups were compared. Results compared with endometrial stromal sarcoma of uterine origin, the extrauterine endometrial stromal sarcoma had the following characteristics: (1) the clinical manifestations were different, pelvic mass accounted for the majority (45.5%), abnormal vaginal bleeding was rare, (2) preoperative serum CA125 level was the same. (3) there was no significant difference in pathological subtypes and immunohistochemical staining between FIGO staging (P.001); (4) and endometriosis (36.4 vs 9.331); (5). There was no significant difference in age, menstrual status, preoperative CA125 level, pathological type, staging, and immunohistochemical features between patients with endometrium stromal sarcoma and those without endometriosarcoma. The proportion of patients with abnormal CA125 may be higher in patients with endometriosis. Conclusion compared with endometrial stromal sarcoma of uterine origin, extrauterine endometrial stromal sarcoma has different clinical features and different clinical manifestations, and the incidence of endometriosis is higher than that of endometrial stromal sarcoma. However, there was no difference between pathological classification and immunohistochemistry. These results suggest that the origin of endometrial stromal sarcoma may be closely related to endometriosis.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33
【参考文献】
相关期刊论文 前3条
1 冷金花;郎景和;;子宫内膜异位症恶变的研究现状[J];实用肿瘤杂志;2006年06期
2 周先荣;;子宫肉瘤的组织学分类及临床病理学特征[J];实用妇产科杂志;2012年01期
3 冷金花,郎景和;子宫内膜异位症恶变的研究进展[J];中华妇产科杂志;2002年07期
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