Department of Pathology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University School of Oncology, Beijing Cancer Hospital & Institute, China.
Best Pract Res Clin Obstet Gynaecol. 2011 Dec;25(6):719-32. doi: 10.1016/j.bpobgyn.2011.07.004. Epub 2011 Aug 6.
Endometrial stromal sarcomas are the second most common uterine sarcomas. Currently, they are classified into low-grade endometrial stromal sarcomas and undifferentiated endometrial sarcoma. Low-grade endometrial stromal sarcomas are biologically low-grade uterine sarcomas, and typically composed of uniform cells intimately associated with prominent arterioles, resembling the endometrial stroma in proliferative phase. There is usually little cytological atypia or pleomorphism, and mitoses are scanty. In contrast, undifferentiated endometrial sarcomas are frankly malignant, lack specific differentiation and any features of normal endometrial stroma. It is a highly aggressive neoplasm, often exhibiting myometrial invasion, haemorrhage and necrosis, as well as marked nuclear pleomorphism and high mitotic activity. The diagnosis of undifferentiated endometrial sarcoma is reached after excluding other uterine tumours with a sarcomatous component, such as adenosarcoma and malignant mixed Müllerian tumour. Histological variants of endometrial stromal sarcomas, including the so called 'high-grade endometrial stroma sarcomas' are addressed. The problems with histologic diagnosis and application of immunohistochemical studies and molecular pathology are highlighted.
子宫内膜间质肉瘤是第二类常见的子宫肉瘤。目前，它们被分为低级别子宫内膜间质肉瘤和未分化子宫内膜肉瘤。低级别子宫内膜间质肉瘤是生物学上低度恶性的子宫肉瘤，通常由与明显的小动脉密切相关的均匀细胞组成，类似于增生期的子宫内膜基质。通常细胞异型性或多形性很小，有丝分裂稀少。相比之下，未分化子宫内膜肉瘤是明显的恶性肿瘤，缺乏特定的分化和任何正常子宫内膜基质的特征。它是一种高度侵袭性的肿瘤，常表现为子宫肌层浸润、出血和坏死，以及明显的核多形性和高有丝分裂活性。在排除具有肉瘤成分的其他子宫肿瘤（如腺肉瘤和恶性混合 Müller 瘤）后，才能诊断为未分化子宫内膜肉瘤。本文还讨论了子宫内膜间质肉瘤的组织学变异型，包括所谓的“高级别子宫内膜间质肉瘤”。强调了组织学诊断以及免疫组织化学研究和分子病理学应用中的问题。
