子宫颈微偏腺癌9例临床病理分析

Minimal deviation adenocarcinoma of uterine cervix:a clinical and pathological study of 9 cases

目的探讨子宫颈微偏腺癌（MDAC）的临床病理特征、诊断和鉴别诊断。方法收集9例子宫颈MDAC的临床病理资料，采用HE染色和免疫组化进行观察。结果患者年龄31～56岁（平均47岁），临床上大多表现为多功能性子宫出血、阴道分泌物增多、绝经后阴道流血、腹胀。子宫颈较正常增大、质硬、脆。组织学特点为腺体扭曲、外形不规则，浸润宫颈壁全层，以及纤维组织增生性的间质反应，腺上皮呈CEA阳性。术后随访至2006年10月，5例死于肿瘤复发和广泛转移；3例分别在术后15个月、46个月和8年复发，放疗后至随访期末尚存活；仅1例术后2年未见复发。结论子宫颈MDAC少见，呈侵袭性生物学行为，预后较差，临床和病理上均易误诊为宫颈其他多种良好肿瘤及瘤样病变。

Objective To investigate the clinicopathological characteristics and differential diagnosis of minimal deviation adenocarcinoma （MDAC） of uterine cervix. Methods The clinical data of 9 cases of MDAC retrieved from our autopsy and surgical pathology files over the last decade were reviewed, and were studied by histopathological observation and immunohistochemical staining. Results The patients ranged in age from 31 to 56 years （ average 47 years）. The most common presenting symptom was menometrorrhagia, followed by vaginal discharge, postmenopansal bleeding, and abdominal swelling in decreasing order of frequency. The cervix was enlarged, indurated and fragile. Microscopic examination showed glands that were irregular in size and shape. The tumors typically exhibited deep invasion of the cervical wall, and a portion of the infiltrating tumor was associated with a desmoplastic stromal response in most cases. The tumor cells were cytoplasmic immunopositive for carcinoembryonic antigen （CEA） staining. Despite radical therapy in all of the cases,the prognosis was poor. Five of them died of recurrent tumor,three were alive with recurrent tumor at the time of last follow - up examination,and only 1 patient was disease free for 2 years. Conclusion MDAC of the uterine cervix is rare variant of cervical adenocarcinoma with poor outcome. It can be confused clinically and pathologically with a variety of pseudoneoplastic glandular lesions of the uterine cervix. Microscopic features that were most helpful in distinguishing adenoma malignum from pseudoneoplastic glandular lesion were the presence of markedly irregular, abnormally shaped glands,invasion of the cervical wall, a loose edematous or desmoplastic stromal response, and positive staining for CEA.