宫颈微小偏离性腺癌的诊治分析

Analysis of the diagnosis and treatment of cervical minimal deviation adenocarcinoma

目的研究宫颈微小偏离性腺癌（MDA）的临床特点及诊治方法。方法回顾性总结15例MDA的临床资料，分析临床表现、辅助检查、病理、治疗方法及随诊情况。结果15例MDA中，有11例治疗前行宫颈脱落细胞学检测，其中3例（27．3％）提示腺癌或可疑腺癌；有8例（53．3％）宫颈活检病理结果为MDA；有2例行诊断性锥切。病理学检查显示，6例手术患者宫颈切面可见多个囊腔。镜下见宫颈腺体不规则增生，肿瘤细胞异型性小，免疫组化CEA、α-SMA阳性。全组患者中位随访时间为51．0个月，5年生存率为85．7％；复发4例，均在术后2年出现阴道、盆腔复发；死亡3例，平均生存时间为36．3个月。结论MDA较少见，其肿瘤细胞异型性小，临床及病理诊断较困难，必要时应及时行宫颈深部组织切除或锥切，免疫组化可提高病理诊断的准确性。MDA治疗以手术为主，必要时可辅助放疗和（或）化疗。

Objective To analyze the characteristics of cervical minimal deviation adenocarcinoma （MDA） and the methods of diagnosis and treatment. Methods A retrospective study was carried out to evaluate the clinical and pathological data of 15 patients with MDA treated from 1992 to 2007. Results The average age of the 15 patients was 42.3 years. The main symptoms were increased discharge and irregular vaginal bleeding. Preoperative Pap smears showed adenocarcinoma in 3 cases （27.3%）. The diagnosis of MDA was confirmed in 8 cases by cervical punch biopsies （53.3%） and 2 cases by conization. Several cysts were noted in sections of the endocervix. Microscopic examination showed glands irregular in size and shape. However, the deviation of tumor cells was minimal. Immunohistochemistry revealed positive expression of CEA and α-SMA. The mean follow-up time was 51.0 months. The overall 5-year survival rate was 85.7%. Four cases experienced recurrence in the vagina and pelvis at 2 years after operation. Three cases died of the disease relapse with an average survival time of 36. 3 months. Conclusion Cervical minimal deviation adenocarcinoma is rare, with minimal deviation of cell shape from the normal cervical cells and difficult in diagnosis. A deep biopsy or conization is necessary when punch biopsy is not sufficient for diagnosis. Immunohistochemistry is helpful to make an accurate diagnosis. Surgery is the first choice for cervical minimal deviation adenocarcinoma. Radiotherapy and/or chemotherapy should be given if needed. The prognosis can be improved if a proper treatment plan is carried out.