Hu D, Zhang H J, Shen W C, Zhu W F, Li L, Lin X D, Lu J P, Zheng X W, Wang C, Zhou X R
Department of Pathology, Fujian Provincial Cancer Hospital, the Affiliated Hospital of Fujian Medical University, Fuzhou 350014, China.
Zhonghua Bing Li Xue Za Zhi. 2017 May 8;46(5):318-322. doi: 10.3760/cma.j.issn.0529-5807.2017.05.007.
To investigate the clinicopathologic features of microcystic, elongated and fragmented (MELF) pattern invasion of endometrial adenocarcinoma. HE and immunohistochemistry staining method were used to analysis morphologic features and immunophenotype of 72 patients of endometrial adenocarcinoma with MELF pattern invasion, and chi-square test was used to analysis the clinicopathologic features. The mean age of 72 patients was 54 years (40 to 70 years). Thirty-two patients were pre-menopausal and 40 were post-menopausal. According to the FIGO staging system (2014), 32 cases(44.4%)were at stage Ⅰ, 22 cases(30.6%)at stage Ⅱ, 17 cases(23.6%)at stage Ⅲ and 1 case(1.4%) at stage Ⅳ. Microscopically, MELF invasion showed microcystic, elongated slit-like or fragmented glands in myometrium and their lining cells usually were cube or flat, as well as the single or clusters of eosinophilic tumor cells mimicking histocytes. In addition, a fibromyxoid or inflammatory stromal response was often present.Immunohistochemical staining showed that MELF invasion was positive for p16, CA125 and CA19-9, but negative for ER, PR and p53.Compared with non-MELF pattern invasion, significant differences were noted in menopause pausimenia, FIGO stages, deep invasion into myometrium, lymph metastasis, lymphovascular space invasion (LVSL), serum CA125 and CA19-9 in patients with MELF pattern invasion (all <0.05). MELF pattern invasion of endometrial adenocarcinoma is characterized by advanced FIGO stage, deep myoinvasion, high metastasis rate to lymph node and LVSL. Pathologists should recognize the MELF invasion and evaluate the depth of myometrium of infiltration and LVSL with special attention to the presence of MELF invasion with necessary immunohistochemistry for more accurate pathological diagnosis.
探讨子宫内膜腺癌微囊状、细长形及破碎状（MELF）浸润模式的临床病理特征。采用苏木精-伊红（HE）染色和免疫组织化学染色方法分析72例具有MELF浸润模式的子宫内膜腺癌患者的形态学特征和免疫表型，并采用卡方检验分析其临床病理特征。72例患者的平均年龄为54岁（40至70岁）。32例为绝经前患者，40例为绝经后患者。根据国际妇产科联盟（FIGO）分期系统（2014年），Ⅰ期32例（44.4%），Ⅱ期22例（30.6%），Ⅲ期17例（23.6%），Ⅳ期1例（1.4%）。显微镜下，MELF浸润表现为肌层内微囊状、细长的裂隙状或破碎的腺体，其衬里细胞通常为立方状或扁平状，以及单个或成群的嗜酸性肿瘤细胞，类似组织细胞。此外，常出现纤维黏液样或炎性间质反应。免疫组织化学染色显示，MELF浸润p16、CA125和CA19-9呈阳性，但雌激素受体（ER）、孕激素受体（PR）和p53呈阴性。与非MELF浸润模式相比，MELF浸润模式患者在绝经状态、FIGO分期、肌层深层浸润、淋巴结转移、脉管间隙浸润（LVSL）、血清CA125和CA19-9方面存在显著差异（均P<0.05）。子宫内膜腺癌的MELF浸润模式具有FIGO分期晚、肌层浸润深、淋巴结转移率高和LVSL的特点。病理学家应认识到MELF浸润，并评估肌层浸润深度和LVSL，尤其要注意MELF浸润的存在，必要时进行免疫组织化学检查以获得更准确的病理诊断。
