Truskinovsky Alexander M, Gerscovich Eugenio O, Duffield Curtis R, Vogt Philip J
Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota 55455, USA.
Int J Gynecol Pathol. 2008 Jan;27(1):61-7. doi: 10.1097/pgp.0b013e31812e95cb.
Endometrial microcalcifications are uncommon, with alleged clinical implications ranging from innocuous to ominous. We reviewed the histopathologic slides from 29 patients who had endometrial echogenic foci on pelvic ultrasound and found many endometrial microcalcifications. The extent of microcalcifications in each specimen was graded on a semiquantitative scale from 0 to 3. The mean patient age was 54 years (range, 34-81 years). The specimens included endometrial biopsies, curettages, and hysterectomies. Most of the patients had presented with abnormal vaginal bleeding. Fifteen patients (51.7%) were postmenopausal, 10 (34.5%) were premenopausal, and the rest were perimenopausal. The most frequent endometrial types were atrophic (39.5%), inactive (23.3%), and proliferative (14%). Six specimens (14%) showed benign endometrial polyps. One patient had well-differentiated endometrioid carcinoma of the endometrium without myometrial invasion. Specimens from 16 patients (55.2%) had microcalcifications. The patients with calcifications were older than those without calcifications (mean age, 60 vs. 47 years, respectively; P = 0.017). The extent of microcalcifications positively correlated with the presence of endometrial polyps (P = 0.00076), postmenopausal state (P = 0.004), atrophic endometrium (P = 0.002), and hormone replacement therapy (P = 0.013). The microcalcifications were concentric or amorphous, intraglandular or stromal. They were focally associated with minute papillary epithelial projections or with degenerated endometrial glands. Follow-up was available on 26 patients (89.7%). Except for the patient with endometrioid carcinoma, none has developed uterine, adnexal, or peritoneal malignancy. In summary, endometrial microcalcifications are histologically heterogeneous and are associated with older patient age, postmenopausal state, atrophic endometrium, and endometrial polyps. Those found incidentally by means of pelvic ultrasonography, in our experience, did not portend malignancy.
子宫内膜微钙化并不常见，其所谓的临床意义从无害到凶险不等。我们回顾了29例盆腔超声检查显示子宫内膜有回声灶患者的组织病理学切片，发现了许多子宫内膜微钙化。每个标本中微钙化的程度按照0至3的半定量标准进行分级。患者的平均年龄为54岁（范围34 - 81岁）。标本包括子宫内膜活检、刮宫组织和子宫切除标本。大多数患者表现为异常阴道出血。15例患者（51.7%）处于绝经后，10例（34.5%）处于绝经前，其余为围绝经期。最常见的子宫内膜类型为萎缩型（39.5%）、静止型（23.3%）和增殖型（14%）。6个标本（14%）显示为良性子宫内膜息肉。1例患者患有高分化子宫内膜样癌，未侵犯肌层。16例患者（55.2%）的标本有微钙化。有钙化的患者比无钙化的患者年龄大（平均年龄分别为60岁和47岁；P = 0.017）。微钙化的程度与子宫内膜息肉的存在（P = 0.00076）、绝经后状态（P = 0.004）、萎缩性子宫内膜（P = 0.002）以及激素替代疗法（P = 0.013）呈正相关。微钙化呈同心状或无定形，位于腺体内或间质内。它们局部与微小乳头状上皮突起或退化的子宫内膜腺体相关。对26例患者（89.7%）进行了随访。除了患有子宫内膜样癌的患者外，没有患者发生子宫、附件或腹膜恶性肿瘤。总之，子宫内膜微钙化在组织学上具有异质性，与患者年龄较大、绝经后状态、萎缩性子宫内膜和子宫内膜息肉有关。根据我们的经验，通过盆腔超声偶然发现的微钙化并不预示着恶性肿瘤。
