【摘要】：研究背景 子宮內(nèi)膜異位癥在組織學(xué)上是一種良性疾病,但卻有局部浸潤(rùn)、遠(yuǎn)處轉(zhuǎn)移等惡性生物學(xué)行為的表現(xiàn),并且內(nèi)異癥組織可發(fā)生惡變。內(nèi)異癥惡變相關(guān)腫瘤包括多種病理類(lèi)型,最常見(jiàn)的是腺癌(70%)和肉瘤(12%),Higashiura等將內(nèi)異癥惡變相關(guān)腫瘤分為以下幾種(1)卵巢上皮性腫瘤,以子宮內(nèi)膜樣癌、透明細(xì)胞癌為主；(2)其它苗勒氏管腫瘤；(3)肉瘤,以子宮內(nèi)膜間質(zhì)肉瘤、腺肉瘤為主。目前內(nèi)異癥病灶腺上皮細(xì)胞惡變與卵巢癌的關(guān)系方面已有較多的文獻(xiàn)報(bào)道,內(nèi)異癥病灶子宮內(nèi)膜間質(zhì)細(xì)胞惡變與子宮肉瘤的關(guān)系的研究少見(jiàn),它的臨床特點(diǎn)、病理表現(xiàn)、預(yù)后因素尚不清楚。子宮內(nèi)膜間質(zhì)肉瘤可發(fā)生于子宮外組織,現(xiàn)有兩種理論解釋其成因,一是子宮內(nèi)膜異位癥組織惡變形成,另一是由盆腔間皮原始苗勒氏細(xì)胞惡變形成。研究子宮外子宮內(nèi)膜間質(zhì)肉瘤的臨床病理特點(diǎn)、及其與子宮內(nèi)膜異位癥的關(guān)系,有助于加深對(duì)子宮外子宮內(nèi)膜間質(zhì)肉瘤來(lái)源、及其與子宮內(nèi)膜異位癥惡變的關(guān)系的理解。 研究目標(biāo) 探索子宮外子宮內(nèi)膜間質(zhì)肉瘤的臨床特點(diǎn)及其與子宮內(nèi)膜異位癥的關(guān)系。 方法 回顧性分析北京協(xié)和醫(yī)院2002年12月至2012年12月期間接受手術(shù)的子宮內(nèi)膜間質(zhì)肉瘤患者的資料,(1)按照病變部位將其分為兩組：子宮起源的子宮內(nèi)膜間質(zhì)肉瘤組和子宮外子宮內(nèi)膜間質(zhì)肉瘤組,比較兩組的臨床和病理特點(diǎn),(2)根據(jù)是否合并子宮內(nèi)膜異位癥將子宮外子宮內(nèi)膜間質(zhì)肉瘤患者分為兩組：合并內(nèi)異癥的子宮外子宮內(nèi)膜間質(zhì)肉瘤組和不合并內(nèi)異癥的子宮外子宮內(nèi)膜間質(zhì)肉瘤組,比較兩組的臨床和病理特點(diǎn)。 結(jié)果 與子宮起源的子宮內(nèi)膜間質(zhì)肉瘤相比,子宮外子宮內(nèi)膜間質(zhì)肉瘤有以下特點(diǎn)：(1)臨床表現(xiàn)不同,盆腔包塊占多數(shù)(45.5%,P=0.010),異常陰道流血少見(jiàn)；(2)術(shù)前血清CA125水平相當(dāng)；(3)診斷時(shí)FIGO分期期別較晚(P.001)；(4)更易合并子宮內(nèi)膜異位癥(36.4%vs9.3%,P=0.031)；(5)病理亞型及免疫組織化學(xué)染色無(wú)明顯區(qū)別。 子宮外子宮內(nèi)膜間質(zhì)肉瘤患者中,合并內(nèi)異癥組與不合并內(nèi)異癥組相比,兩者在年齡、月經(jīng)狀態(tài)、術(shù)前CA125水平、病理分型、分期、免疫組化特點(diǎn)方面無(wú)明顯區(qū)別,合并內(nèi)異癥組中CA125異�；颊叩谋壤赡芨�。 結(jié)論 與子宮起源的子宮內(nèi)膜間質(zhì)肉瘤相比,子宮外子宮內(nèi)膜間質(zhì)肉瘤具有不同的臨床特點(diǎn),臨床表現(xiàn)不同,合并內(nèi)異癥的比例較高,但其病理分型及免疫組化并無(wú)區(qū)別。提示子宮外子宮內(nèi)膜間質(zhì)肉瘤的起源可能與內(nèi)異癥密切相關(guān)。
[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.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R737.33

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