De Nictolis M, Curatola A, Tommasoni S, Magiera G
Institute of Morbid Anatomy, University of Ancona, General Regional Hospital, Torrette.
Pathologica. 1994 Apr;86(2):217-21.
This report describes a case of high-grade stromal sarcoma occurring in a 53-year-old woman. Preoperative and pathologic findings showed up a large tumoral nodule confined to the uterus. The patient underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy and dissection of pelvic and para-aortic lymph-nodes; successively she underwent pelvic and abdominal radiotherapy and chemotherapy, which was discontinued because of leukopenia. Histologically the tumor was made up of cells resembling endometrial stromal cells with only mild cytologic atypia and had up to 24 mitoses x 10 HPF in the most cellular areas. Immunohistochemically it showed a diffuse positivity for vimentin and a focal positivity for muscular actin and desmin. The patient died of this disease nine months postoperatively. These features underline that a uterine sarcoma with histological features similar to a low-grade endometrial stromal sarcoma but with high mitotic rate may behave as a very aggressive tumor even when diagnosed at the initial stage; the immunohistochemical data indicate that these tumors may show smooth-muscle differentiation.
本报告描述了一例发生在一名53岁女性身上的高级别间质肉瘤病例。术前和病理检查结果显示子宫内有一个大的肿瘤结节。患者接受了全腹子宫切除术、双侧输卵管卵巢切除术、大网膜切除术以及盆腔和腹主动脉旁淋巴结清扫术；随后接受了盆腔和腹部放疗及化疗，但因白细胞减少而停药。组织学上，肿瘤由类似子宫内膜间质细胞的细胞组成，仅有轻度细胞学异型性，在细胞最丰富的区域每10个高倍视野有多达24个有丝分裂象。免疫组化显示波形蛋白弥漫阳性，肌动蛋白和结蛋白局灶阳性。患者术后9个月死于该病。这些特征强调，具有与低级别子宫内膜间质肉瘤相似组织学特征但有高有丝分裂率的子宫肉瘤，即使在疾病初期诊断时，也可能表现为极具侵袭性的肿瘤；免疫组化数据表明这些肿瘤可能显示平滑肌分化。
