结直肠子宫内膜异位症误诊腺癌2例并文献复习
摘要
目的了解结直肠子宫内膜异位症的临床病理特征及临床诊治情况。方法回顾分析牡丹江医学院附属红旗医院2例结直肠肠子宫内膜异位症患者临床病理特征,并复习相关文献。结果 2例患者均为已婚中年女性,均有排便习惯改变,例1有血便史,例2有痛经及肛门坠胀感。肠镜检查均见隆起病变/新生物。肠镜活检的组织学形态:粘膜层均见小灶异位子宫内膜腺体和间质。2例均行结肠手术切除,手术标本组织学显示异位子宫内膜侵犯肠壁全层达粘膜层。免疫组化:异位腺体表达CK7和ER,其周围间质细胞表达CD10,周边残存肠粘膜表达CK20。例2见淋巴结累犯。结论育龄妇女结直肠粘膜活检标本需考虑到除外子宫内膜异位症的可能;肠镜活检识别子宫内膜异位症特征性改变加做免疫组化,有助于鉴别诊断;肠管部分切除是肠粘膜子宫内膜异位症的主要治疗方法。
引文
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[4] 王姝,朗景和,章蓉娅.人类雄激素受体基因检测子宫内膜异位症病灶克隆性[J].中华妇产科杂志,2010,8(45):593-595.
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[8] WEI J,ANDRES A R,KEITH L,et al.Endometriosis involing the mucosa of the intestinal tract:a clinicopathologic study of 15 casea[J].Moder Patho,2013(26):1270-1278.
[9] ABRAO M S,PODGEC S,PIAS J A,et al.Deeply infiltrating endometriosis affecting the rectum and lymph nodess[J].Fertil Steril,2006,86(3):543-547.
[10] CLEMENT P B.The pathology of endometriosis:a survey of the many faces of a common disease emphasizing diagnostic pitfalls and unusual and newly appreciated aspects[J].Adv Anat Pathol 2007(14):241-260.
[11] 吴勇军主译.术中冰冻切片诊断误区[M],人民卫生出版社,2016:130.
[2] VERCELLINI P,VIGANO P,SOMIGLIANA E,et al.Endometriosis:pathogen-esis and treatment[J].Nat Rev Endocrinol.2014(10):261-275.
[3] 朗景和.关于子宫内膜异位症的再认识及意义[J].中国工程科学,2009,11(10):137-140.
[4] 王姝,朗景和,章蓉娅.人类雄激素受体基因检测子宫内膜异位症病灶克隆性[J].中华妇产科杂志,2010,8(45):593-595.
[5] CHAPRON C,FAUCONNIER A,VIEIRA M,et al.Anatomical distribution of deeply infiltrating endometriosi:surgical implications and proposition for a classification[J].Hum Reprod,2003,18(1):157-161.
[6] REMORGIDA V,FERRERO S,FULCHERI E,et al.Bowel endometriosis:presentation,diagnosis,and treatment[J].Obstet Gynecol Serv,2007,62(7):461-470.
[7] HUI C,QIUPING L,SHAOYUAN L,et al.Rectal mucosal endometrisis primarily misinterpreted as adenocarcinoma:a case report and review of literature[J].Int J Clin Exp Pathol,2015,8(5):5902-5907.
[8] WEI J,ANDRES A R,KEITH L,et al.Endometriosis involing the mucosa of the intestinal tract:a clinicopathologic study of 15 casea[J].Moder Patho,2013(26):1270-1278.
[9] ABRAO M S,PODGEC S,PIAS J A,et al.Deeply infiltrating endometriosis affecting the rectum and lymph nodess[J].Fertil Steril,2006,86(3):543-547.
[10] CLEMENT P B.The pathology of endometriosis:a survey of the many faces of a common disease emphasizing diagnostic pitfalls and unusual and newly appreciated aspects[J].Adv Anat Pathol 2007(14):241-260.
[11] 吴勇军主译.术中冰冻切片诊断误区[M],人民卫生出版社,2016:130.