14例宫颈微偏离腺癌临床病理分析

Minimal deviation adenocarcinoma of cervix：a clinicopathologic analysis of 14 cases.

目的通过14例宫颈微偏离腺癌（MDA）临床病理学分析，进一步探讨MDA的临床症状、病理形态及免疫组化特征。方法收集14例宫颈MDA病理活检和／或全子宫切除标本进行巨检、光镜观察，其中9例行免疫组化染色测定CEA、p16、p53、Ki-67、CA125、ER、PR、HPV16／18等免疫表型。结果14例患者平均年龄48．5岁，临床症状主要表现为宫颈水样溢液，伴或不伴接触性出血，体征多数为宫颈肥大、增粗变硬和／或宫颈糜烂。术前病理活检确诊为8例，术后随访3-6个月，其中2例分别于6个月和7个月死亡，3例转移，4例健在，余4例失访。结论宫颈MDA的早期确诊率极低，应高度警惕宫颈水样溢液和／或宫颈肥大、增粗变硬者，应尽量深取组织（〉5mm），必要时施行高频电刀宫颈锥形切除术。CEA、p53（＋）及CA125、ER（-）具有辅助诊断价值。

Objective To discuss the features, such as clinical symptoms, pathologic morphologies, immunohistochemical staining of minimal deviation of the adenocarcinoma of the cervix （MDA） in order to obtain the early diagnosis. Methods Gross, microscopic changes of biopsies and total hysterectomies were analyzed in 14 cases of cervical MDA and immunohistochemical staining was used to detect the expression of CEA, p16, p53, Ki - 67, CA125, ER, PR and HPV16/18 in 9 cases. Results The average age was 48.5 years for the 14 patients. The main symptoms included the watery discharge of cervix, with or without the irregular hemorrhage of rterus. Of all the cases, eight were followed - up for 3 - 60 months postoperatively. Of them , two cases died for 6 and 7 months, metastatic diseases occurred in 3 cases, and disease - free survivals were found in 4. The follow - up was lost for the other 4 cases. Conclusion The early diagnosis rate of the cervical MDA is very low, to which we must pay more attention. For patients with watery discharge and/or hypertrophy of cervix, The deep （ 〉 5mm） biopsies should be performed , When necessary , electric knife conization should be performed . The immunohistochemical staining for CEA , p53, Ki -67, CA125 and ER has adjuvant diagnostic values.