Guedj Nathalie, Côte Jean-Francois, Lepimpec-Barthes Françoise, Badoual Cécile, Carnot Francoise, Riquet Marc, Danel Claire
Service d'anatomie pathologie, hôpital Beaujon, 92 Clichy, France.
Ann Pathol. 2009 Dec;29(6):475-80. doi: 10.1016/j.annpat.2009.10.024.
Thoracic endometriosis (TE) is rare with positive histological diagnosis sometimes difficult, particularly in atypical form. The aim of this study was to identify features which can increase performance of the histolological TE diagnosis and more particularly immuno-histochemical (IHC) contribution with hormonal receptors, smooth muscle actin, Ber-Ep4, CD10 and calretinin antibodies. To address this issue, we retrieved, retrospectively, a large series of 591 pneumothorax operated. Among them, 135 (23%) were females including eight (6%) cases related to TE. Those eight women were surgically treated with resection of pleura (n=6/8), lung (n=5/8) and diaphragmatic samples (n=6/8). Typical histological lesions of endometriosis were observed in six cases among eight. All diaphragmatic samples presented, macroscopically, holes responsible of thoraco-abdominal communication (n=6/6). Endometrial glands and/or endometrial stroma cells were found in the diaphragm (n=5/6) and in the pleura (n=2/6) but were never encountered in the lung (n=0/5). IHC study can confirm the five diaphragmatic localizations and can identify a new localization with expression of hormonal receptors, CD10 and smooth muscle actin in an island of fusiform cells. In conclusion, our study shows 1) the high frequency of diaphragmatic endometriosis localization which holes existence also can explain the pathogenesis, 2) the value of diaphragmatic samples in positive histological diagnosis of TE, 3) IHC interest to confirm endometriosis, particularly in atypical form and to differentiate from mesothelial cells inclusion.
胸段子宫内膜异位症（TE）较为罕见，组织学确诊有时存在困难，尤其是非典型形式。本研究的目的是确定能够提高组织学诊断TE的效能的特征，更具体地说是确定激素受体、平滑肌肌动蛋白、Ber-Ep4、CD10和钙视网膜蛋白抗体在免疫组织化学（IHC）中的作用。为解决这一问题，我们回顾性检索了591例接受气胸手术的病例。其中，135例（23%）为女性，包括8例（6%）与TE相关的病例。这8名女性接受了胸膜（n=6/8）、肺（n=5/8）和膈肌样本（n=6/8）切除的手术治疗。8例中有6例观察到典型的子宫内膜异位症组织学病变。所有膈肌样本在宏观上均呈现出导致胸腹相通的孔洞（n=6/6）。在膈肌（n=5/6）和胸膜（n=2/6）中发现了子宫内膜腺体和/或子宫内膜间质细胞，但在肺中未发现（n=0/5）。免疫组织化学研究可以证实5例膈肌定位，并能在一个梭形细胞岛中通过激素受体、CD10和平滑肌肌动蛋白的表达确定一个新的定位。总之，我们的研究表明：1）膈肌子宫内膜异位症定位的高频率，其孔洞的存在也可以解释发病机制；2）膈肌样本在TE组织学阳性诊断中的价值；3）免疫组织化学在确诊子宫内膜异位症方面的意义，尤其是在非典型形式中，并能与间皮细胞包涵体相鉴别。
