Nogales F F, Martin F, Linares J, Naranjo R, Concha A
Department of Pathology, University of Granada School of Medicine, Spain.
J Cutan Pathol. 1993 Feb;20(1):87-91. doi: 10.1111/j.1600-0560.1993.tb01257.x.
A case of cesarean scar endometriosis with massive decidualization is presented. The 25-year-old patient had an extensive, ulcerated lesion that mimicked malignancy microscopically due to myxoid change with alveolar patterns reminiscent of some soft tissue sarcomas, signet ring-like cells similar to mucin-producing carcinoma, and pseudoinfiltration of the fascia. The myxoid tissue was positive for acid mucopolysaccharides but negative with PAS. Decidual cells were vimentin positive and keratin negative. No atypia or mitoses were seen. The pseudoinfiltrative aspect was due to abundant extracellular matrix that separated the fascicles of the fascial tissue. There was a metaplastic decidual "proximity effect" in the surrounding, unaffected dermis, which may be responsible for the expansile features of the lesion. This case exemplifies the differential diagnosis of myxoid endometriosis with malignant conditions of the skin.
本文报告一例伴有大量蜕膜化的剖宫产瘢痕子宫内膜异位症病例。该25岁患者有一个广泛的溃疡性病变，在显微镜下类似于恶性肿瘤，原因是存在黏液样改变并伴有肺泡样结构，让人联想到某些软组织肉瘤，有类似黏液产生癌的印戒样细胞，以及筋膜的假浸润。黏液样组织酸性黏多糖呈阳性，但PAS呈阴性。蜕膜细胞波形蛋白呈阳性，角蛋白呈阴性。未见异型性或有丝分裂。假浸润外观是由于丰富的细胞外基质将筋膜组织的束状结构分隔开。在周围未受影响的真皮中有化生的蜕膜“邻近效应”，这可能是病变具有膨胀性特征的原因。该病例体现了黏液样子宫内膜异位症与皮肤恶性疾病的鉴别诊断。
