Abstract：
BACKGROUND: Endometrial stromal tumors (ESTs) are rare subset of mesenchymal uterine neoplasms. There are heterogeneous morphological, immunohistochemical, and genetic features. Approximately 50% of ESTs occur in perimenopausal women. In 2020, WHO sub-categorized ESTs into four groups: endometrial stromal nodule (ESN), low-grade endometrial stromal sarcoma (LGESS), high-grade endometrial stromal sarcoma (HGESS), and undifferentiated uterine sarcoma (UUS).
OBJECTIVE: To review the morphological spectrum of endometrial stromal tumors.
METHODS: This retrospective study reviewed the histomorphological features of 15 endometrial stromal tumors with respect to atypia, necrosis, mitosis, collagen bands, whorling around vessels, myometrial invasion, and inflammatory cells. Immunohistochemistry markers (CD10, SMA, and ER) along with special stains (Masson\'s trichrome, toluidine blue) were also studied.
RESULTS: The age of the patients ranged from 32 to 60 years. Three patients were postmenopausal. The most common presenting symptom was vaginal bleeding. Five patients were operated with a clinical diagnosis of uterine fibroid. One patient presented with prolapse with no other complaint. All the 15 patients had total abdominal hysterectomy and salpingo-oophorectomy. One case showed necrosis, eight cases showed collagen bands, all the 15 cases showed whorling around vessels, one case showed vascular emboli, and seven cases showed inflammatory cells. In low-grade cases, one case showed focal atypia and one case showed focal coagulative necrosis indicating infarction. Thirteen cases were LGESS, and one case of ESN and HGESS. All cases were positive for ER and CD10.
CONCLUSIONS: Endometrial stromal tumors demonstrate extensive permeation of the myometrium as irregular islands with frequent vascular invasion, whorling around vessels, collagen bands, and inflammatory cells. All these features should be observed thoroughly on microscopy by pathologists to clearly differentiate the low-grade and high-grade endometrial stromal tumors, and to understand the overlapping gray areas morphologically as it affects the prognosis of the patient.
OBJECTIVE: To review the morphological spectrum of endometrial stromal tumors.
METHODS: This retrospective study reviewed the histomorphological features of 15 endometrial stromal tumors with respect to atypia, necrosis, mitosis, collagen bands, whorling around vessels, myometrial invasion, and inflammatory cells. Immunohistochemistry markers (CD10, SMA, and ER) along with special stains (Masson\'s trichrome, toluidine blue) were also studied.
RESULTS: The age of the patients ranged from 32 to 60 years. Three patients were postmenopausal. The most common presenting symptom was vaginal bleeding. Five patients were operated with a clinical diagnosis of uterine fibroid. One patient presented with prolapse with no other complaint. All the 15 patients had total abdominal hysterectomy and salpingo-oophorectomy. One case showed necrosis, eight cases showed collagen bands, all the 15 cases showed whorling around vessels, one case showed vascular emboli, and seven cases showed inflammatory cells. In low-grade cases, one case showed focal atypia and one case showed focal coagulative necrosis indicating infarction. Thirteen cases were LGESS, and one case of ESN and HGESS. All cases were positive for ER and CD10.
CONCLUSIONS: Endometrial stromal tumors demonstrate extensive permeation of the myometrium as irregular islands with frequent vascular invasion, whorling around vessels, collagen bands, and inflammatory cells. All these features should be observed thoroughly on microscopy by pathologists to clearly differentiate the low-grade and high-grade endometrial stromal tumors, and to understand the overlapping gray areas morphologically as it affects the prognosis of the patient.
摘要：
背景：子宫内膜间质瘤（ESTs）是子宫间叶性肿瘤的罕见亚组。有不均匀的形态学，免疫组织化学，和遗传特征。大约50％的EST发生在围绝经期妇女中。2020年，WHO将EST分为四组：子宫内膜间质结节（ESN），低度子宫内膜间质肉瘤（LGESS），高级别子宫内膜间质肉瘤（HGESS），未分化子宫肉瘤（UUS）。
目的：综述子宫内膜间质瘤的形态学谱。
方法：这项回顾性研究回顾了15例子宫内膜间质瘤的异型性组织形态学特征，坏死,有丝分裂,胶原蛋白带，绕着船只旋转，子宫肌层浸润，和炎症细胞。免疫组织化学标记（CD10，SMA，和ER)以及特殊污渍(马森三色，甲苯胺蓝）也进行了研究。
结果：患者的年龄范围为32至60岁。3例患者绝经后。最常见的症状是阴道出血。5例患者接受了子宫肌瘤的临床诊断。一名患者出现脱垂，无其他主诉。15例患者均行腹式全子宫切除术和附件卵巢切除术。一例显示坏死,八例显示胶原蛋白带，所有15例病例都显示在血管周围旋转，一例显示血管栓塞,7例显示炎症细胞。在低级案件中，1例显示局灶性非典型性，1例显示局灶性凝固性坏死，表明梗塞。13例是LGESS,和一例ESN和HGESS。所有病例均为ER和CD10阳性。
结论：子宫内膜间质瘤表现出子宫肌层的广泛渗透为不规则岛，并伴有频繁的血管浸润，绕着船只旋转，胶原蛋白带，和炎症细胞。病理学家应在显微镜下彻底观察所有这些特征，以明确区分低级别和高级别子宫内膜间质瘤。并从形态上了解重叠的灰色区域，因为它会影响患者的预后。
目的：综述子宫内膜间质瘤的形态学谱。
方法：这项回顾性研究回顾了15例子宫内膜间质瘤的异型性组织形态学特征，坏死,有丝分裂,胶原蛋白带，绕着船只旋转，子宫肌层浸润，和炎症细胞。免疫组织化学标记（CD10，SMA，和ER)以及特殊污渍(马森三色，甲苯胺蓝）也进行了研究。
结果：患者的年龄范围为32至60岁。3例患者绝经后。最常见的症状是阴道出血。5例患者接受了子宫肌瘤的临床诊断。一名患者出现脱垂，无其他主诉。15例患者均行腹式全子宫切除术和附件卵巢切除术。一例显示坏死,八例显示胶原蛋白带，所有15例病例都显示在血管周围旋转，一例显示血管栓塞,7例显示炎症细胞。在低级案件中，1例显示局灶性非典型性，1例显示局灶性凝固性坏死，表明梗塞。13例是LGESS,和一例ESN和HGESS。所有病例均为ER和CD10阳性。
结论：子宫内膜间质瘤表现出子宫肌层的广泛渗透为不规则岛，并伴有频繁的血管浸润，绕着船只旋转，胶原蛋白带，和炎症细胞。病理学家应在显微镜下彻底观察所有这些特征，以明确区分低级别和高级别子宫内膜间质瘤。并从形态上了解重叠的灰色区域，因为它会影响患者的预后。
