Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Cedoc, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Paátria, Lisboa, Portugal.
Int J Gynecol Pathol. 2010 Mar;29(2):185-8. doi: 10.1097/PGP.0b013e3181b7015e.
We report for the first time a case of 2.5 cm polypoid cervical endometriosis with a superficial growth pattern in a 48-year-old patient with past tubal ligation. The lesion showed metaplastic changes (clear cell, eosinophilic, micropapillary) and a prominent Arias Stella reaction in the absence of concomitant pregnancy but presumably related to phytoestrogenic treatment. The eutopic endometrium, however, had a usual proliferative appearance, implying that it showed a different response from the endometriotic tissues, suggesting the possibility of a metaplastic origin for the endocervical polypoid endometriosis. The unusual histology of the lesion led to an erroneous diagnosis of papillary serous carcinoma in the biopsy. This was subsequently excluded on finding endometrial-type stroma surrounding glands, and was confirmed immunohistochemically by a low Ki-67 index and negativity for p53.
我们首次报道了一例 48 岁既往输卵管结扎患者的 2.5cm 息肉样宫颈子宫内膜异位症，呈浅表生长模式。病变表现为化生改变（透明细胞、嗜酸性粒细胞、微乳头状）和明显的 Arias-Stella 反应，但无伴随妊娠，推测与植物雌激素治疗有关。然而，在位子宫内膜呈通常的增生性表现，这表明它与子宫内膜异位组织的反应不同，提示宫颈息肉样子宫内膜异位症可能来源于化生。病变的不寻常组织学导致活检误诊为乳头状浆液性癌。随后通过发现围绕腺体的子宫内膜样基质排除了这种情况，并通过低 Ki-67 指数和 p53 阴性的免疫组织化学证实。
