| 唐曼,王晴,张和平,等.宫颈原位腺癌 28例临床病理观察[J].安徽医药,2022,26(7):1394-1397. |
| 宫颈原位腺癌 28例临床病理观察 |
| Adenocarcinoms in situ of the cervical:a clinicolpathological study of 28 cases |
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| DOI：10.3969/j.issn.1009-6469.2022.07.028 |
| 中文关键词: 宫颈肿瘤 腺癌 阴道镜检查 宫颈锥切术 免疫组织化学 |
| 英文关键词: Uterine cervical neoplasms Adenocarcinoma Colposcopy Cervical conization Immunohistochemistry |
| 基金项目: |
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| 中文摘要: |
| 目的探讨宫颈原位腺癌( adenocarcinoma in situ，AIS)的临床病理特征、免疫表型、鉴别诊断、治疗及预后。方法按照第四版 WHO女性生殖器官肿瘤分类标准对 2009年 1月至 2016年 5月安徽省妇幼保健院 28例诊断为宫颈原位腺癌的病例进行重新分类，分析其临床病理学特征并采用免疫组织化学 Envision法检测细胞周期蛋白依赖性激酶抑制剂( p16)、癌胚抗原(CEA)、肿瘤增殖抗原(Ki-67)在其组织中的表达。结果病人年龄范围 26~54岁，中位年龄 39.5岁；临床表现为阴道不规则流血 46.4%(13例)接触性出血 28.6%(8例)阴道排液 3.5%(1例)，其余 6例无明显临床症状；所有病例均先行宫颈活检或宫颈锥切术，组织学特征，24例 AIS为宫颈内膜型，，镜下与正常宫颈黏液上皮相似，上皮空泡状，具有颗粒状胞质，细胞核增大，染色质粗糙，腔缘可见核分裂象和凋亡小体； 3例 AIS为肠型，上皮出现类似于肠上皮的杯状细胞，胞质有大量黏液，位于细胞一侧，局部区域混合有宫颈内膜型 AIS；1例为复层产生黏液的上皮内病变( SMILE)复层上皮的所有细胞都含有黏液空泡，细胞核有异型性，染色质浓染，核分裂象可见； 28例 AIS，17例(60.7%)伴有宫颈鳞状上皮，内病变，其中 2例伴低级别鳞状上皮内病变， 15例伴高级别鳞状上皮内病变。免疫表型: p16、CEA在原位腺癌中的阳性率分别为 96.4%(27/28)85.7%(24/28)，Ki-67增殖指数为 40%~80%。28例中 17例行单纯子宫切除术， 11例行宫颈锥切术， 4例锥切后切缘阳性。 23例，获得随访，中位随访时间 |
| 英文摘要: |
| Objective To investigate the clinicopathological features,immunophenotype, differential diagnosis, treatment and prog-nosis of the adenocarcinoma in situ (AIS) of the cervix.Methods Twenty-eight cases of cervical AIS diagnosed in Anhui Maternal andChild Health Hospital from January 2009 to May 2016 were reclassified according to the fourth edition of WHO classification criteriafor tumors of female genital organs. The clinicopathological features were analyzed, and the expression of cyclin-dependent kinase in-hibitor (P16), carcinoembryonic antigen (CEA), and tumor proliferation antigen (Ki-67) protein in the tissues was detected by immuno-histochemistry.Results The age range of patients ranged from 26 to 54 years old, with a median age of 39.5 years old; the clinicalmanifestations were 46.4 % (13 cases) of irregular vaginal bleeding, 28.6 % (8 cases) of contact bleeding, 3.5 % (1 case) of vaginal dis-charge, and the remaining 6 cases had no obvious clinical symptoms. All patients underwent cervical biopsy or cervical conization, andthe histological characteristics of 24 cases of AIS were cervical endometrial type, AIS was similar to normal cervical mucinous epitheli-um under microscope, the epithelium was vacuolated, with granular cytoplasm, enlarged nucleus, rough chromatin, mitosis and apoptot-ic bodies at the edge of the cavity; 3 cases were intestinal type, goblet cells similar to intestinal epithelium appeared in the epithelium,there was a large amount of mucus in the cytoplasm, which was located on one side of the cells, and mixed with cervical endometrialtype AIS in local area. 1 case was stratified mucin-producting intraepithelial lesion (SMILE), in which all the cells in the stratified epi-thelium contained mucinous vacuoles, nuclear atypia, chromatin staining and mitosis. Of the 28 AIS cases, 17 (60.7 %) had cervicalsquamous cell lesions, including 2 cases were LSIL, and other 15 cases were HSIL. Immunophenotype: the positive rates of p16 andCEA in adenocarcinoma in situ were 96.4 % (27/28), 85.7 % (24/28), and proliferation index of Ki-67 was 40 to 80 %. All patients un-derwent surgery with different methods, 17 cases were treated by hysterectomy, 11 cases were treated by conizationa, and 4 cases hadpositive cutting edge after conization. 23 cases of them were followed up with a median follow-up of 41.5 months. 4 cases were recurred,among them, 2 cases had positive margins, and the pathology was still adenocarcinoma in situ after recurrence; and the other 2 cases re-curred as invasive adenocarcinoma, and then underwent hysterectomy and pelvic lymph node dissection, one patient died 13 months af-ter operation, and one patient survived 8 months without tumor.Conclusions AIS of the cervix has distinct histological features, andoften accompanied by cervical squamous intraepithelial lesions, it was easy to cause misdiagnosis, which may delay the diagnosis anddevelop into invasive cancer, immunohisochemical staining of P16, CEA and Ki-67 may helpful in the diagnosis of AIS. Conization isthe first choice for the treatment of AIS, even hysterectomy if people who have no fertility requirements. Postoperative follow-up is nec-essary. |
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