【摘要】 目的 探讨低度恶性子宫内膜间质肉瘤的诊断经验，以期早期诊断，提高诊断率。方法 结合文献对1例低度恶性子宫内膜间质肉瘤的临床特点、辅助检查、病理学特征进行分析。结果 其临床特点：多发于中年妇女，主要表现为阴道异常出血、子宫增大、下腹疼痛；B超检查见网格状、蜂窝状强弱不均回声，低阻血流丰富，RI比正常值低。组织学特点：瘤细胞似增殖期子宫内膜间质细胞，无明显异型性，核分裂相一般≤3/10HPF,肿瘤组织围绕螺旋小动脉样血管生长，舌状浸润肌层，易见淋巴管内瘤栓。结论 低度恶性子宫内膜间质肿瘤是一种少见的子宫肿瘤，术前诊断率较低。其临床特点无特异性，B超RI、PSV测定为该病的预测提供了新的、有效的方法，MRI、PET在临床的应用将为肿瘤的早期发现、术前定性分级获得重大突破，诊断性刮宫常因其盲目性及肿瘤深在，诊断符合率不高，术中冰冻切片是明确诊断、决定手术范围的较好手段，但由于切片清晰度的局限，也易造成误诊，因此最准确的诊断就是石蜡切片病理诊断。

    【关键词】 肉瘤，子宫内膜间质；诊断；病理学，临床

    Diagnosis of low-grade endometrial stromal sarcoma

    LI Pei-feng,WANG Tao,YAO Qing-duan,et al.Department of Pathology,The 89th Central Hospital of PLA,Weifang 261021,China

    【Abstract】 Objective To investigate the diagnosis of low-grade endometrial stromal sarcoma(LGESS).Methods The clinical characteristics,auxiliary examination and pathologic features were analyzed according to one case and literature review.Results Clinical characteristics:this neoplasm had a definite predilection for middle-aged female.The main clinical signs were abnormal vaginal bleeding,enlarged uterus and pain in lower abdomen.Honeycomb unequal echo of uterine wall were observed by ultrasonography.Microscopic examination demonstrated dense proliferation of spindle cells with little nuclear atypia,which were arranged in whorled pattern around abundant helical arterioles.Mitotic count is below 3 in 10 high-power fields(HPF).The tumor cells present ligulate-invasion reaching the muscular layer and intralymphatic extension.Conclusion LGESS is a rare uterine neoplasm;the rate of preoperative diagnosis is very low.The main clinical signs are nonspecific.The resistance index(RI) and peak systolic velocity(PSV) within the tumor detected by color pulsed Doppler ultrasonography could be a new and effective method for the preoperative differential diagnosis.The application of the magnetic resonance imaging(MRI) and the positron emission tomography(PET) is great breakthroughs in diagnosing the tumor earlier and identifying the quality and grade of tumor.The disadvantage of exploratory curettage is blind on the foci position,and the diagnostic accordance rate is not high.Mid-operation frozen section is a useful method to confirm the diagnosis and determine the region of operation,but misdiagnose often occur for the limitation of clearness.So paraffin section is a precise method for pathological diagnose. ......