Objective: To investigate the clinicopathological features of FIGO stage Ⅰ uterine Müllerian adenosarcoma and clinical prognosis. Methods: Fifteen cases of uterine Müllerian adenosarcoma at FIGO stage Ⅰ were collected at PLA General Hospital from 2005 to 2017. Twelve cases with complete follow-up data were divided into 2 groups: group A (7 patients with survival) and group B(5 patients of death or tumor progression). Clinicopathologic features were compared between the two groups. Results: The median age of the patients was 43 years and 56 years, and the tumor size was 4.3 cm and 7.3 cm for group A and B, respectively. Cases in group A were FIGO ⅠA and ⅠB stage tumors and were mainly low grade in histology (5/7) with rare tumor hemorrhagec, necrosis (1/7) and sarcomatous overgrowth. In contrast, most cases in group B were high grade sarcomas(3/5) with frequent hemorrhage, necrosis(3/5) and sarcomatous overgrowth(4/5). Most cases of group A expressed ER, PR and CD10 (6/7) and low Ki-67 index of ≤20%(5/7). While most group B cases lost expression of ER and PR (3/5), significantly reduced expression of CD10 and higher Ki-67 index of ≥30%(4/5). Conclusions: Most of uterine adenosarcomas are of low malignant potential. The main prognostic indicator is advanced tumor stage. For patients at stage Ⅰ, sarcomatous overgrowth, high-grade histology, deep myometrial invasion, decreased or absent expression of CD10, ER and PR, increased Ki-67 index(≥30%) and hemorrhagic necrosis may indicate poor prognosis. Müllerian adenosarcomas arising from endomeriosis may present unusual growth patterns.
目的： 探讨国际妇产科联盟(FIGO)Ⅰ期子宫Müllerian腺肉瘤患者的预后相关临床病理特征。 方法： 收集2005至2017年就诊于解放军总医院的子宫Müllerian腺肉瘤15例患者临床资料、形态学及免疫组织化学表型，其中12例随访资料完整，根据预后情况分为A(无瘤生存7例)、B(死亡或肿瘤进展5例)两组，比较其临床病理特征并复习相关文献。 结果： A组与B组的患者中位年龄(43岁∶56岁)和肿瘤直径(4.3 cm∶7.3 cm)比较有一定的差异。A组病例分期均不超过FIGO ⅠB期，肉瘤成分以低级别为主(5/7)，少见出血坏死(1/7)，少数病例伴肉瘤成分过度生长(SO)。B组则无FIGOⅠA期病例，多见高级别肉瘤成分(3/5)、出血坏死(3/5)及SO(4/5)。A组肉瘤细胞大多数表达雌激素受体(ER)、孕激素受体(PR)和CD10(均为6/7)，Ki-67阳性指数大多≤20%(5/7)；B组则多数不表达ER、PR(均3/5)，CD10虽多数表达但范围明显减少，Ki-67阳性指数大多≥30%(4/5)。 结论： Müllerian腺肉瘤大多呈低度恶性临床经过，预后不良与分期较晚可能相关。对于FIGO Ⅰ期患者，不良预后可能与SO，高级别肉瘤形态，深肌层浸润，CD10、ER和PR表达降低或缺失，Ki-67阳性指数增高(≥30%)及出血坏死有关。在子宫内膜异位症基础上多中心发生者应视具体情况进行分期。.
Keywords: Adenosarcoma; Mullerian ducts; Prognosis; Uterus.