子宫颈细胞学不典型腺细胞的临床意义

Clinical significance on atypical cervical glandular cytology

目的探讨宫颈细胞学结果中不典型腺上皮细胞（AGC）的组织病理学特点及临床意义。方法选择87例富颈细胞学AGC患者，分析其阴道镜检查，宫颈活检、分段诊刮、子宫颈电热圈环切术（LEEP）的病理及随访结果。结果（1）87例中病理异常35例（40．23％）：腺上皮病变10（11．49％）例，包括子宫内膜轻度非典型增生2例、宫颈腺上皮内瘤变3例、宫颈腺癌3例、子宫内膜腺癌2例；宫颈鳞状上皮内病变（CIN）25例（28．74％）。（2）61例细胞学AGC不明意义（AGC NOS）有18例病理异常（29．51％）；16例AGC提示倾向内瘤变（AGC SIL）中有9例组织学异常；10例为原位腺癌（AIS）／腺癌中，6例病理异常。病理异常在细胞学AGC NOS与AGC SIL或AIS比较差异有统计学意义，P〈0．05。（3）除2例子宫内膜腺癌及3例宫颈腺癌行开腹手术外，余82例行随访，随访率100％。随访时间6～46个月。随访中3例再次出现细胞学异常，经病理证实1例CIN1、1例CIN2、1例CIN3。（4）10例病理腺上皮病变中，除1例CGIN1患者的年龄〈35岁，余年龄均≥35岁。结论AGC中40．23％的患者有组织学异常。因存在CIN及癌，应行阴道镜检查及组织学确诊。疾病的存在与年龄有关，年龄〉135岁的患者存在腺癌和子宫内膜癌的概率增加，因此应重视年龄35岁以上妇女宫颈细胞学AGC的结果。

Objective To determine the pathological features and clinical implications of atypical glandular cells of undetermined significance （AGC） in cervical cytological results. Methods All 87 cases of cervical cytological examinations with AGC were identified by a computerized database in our patient population. The authors analyzed the cervical histopathological results by colposcopic biopsy, dilatation and curettage（D＆C）, cervical loop electrosurgical excision procedure （LEEP）and follow-ups. Results （1） Thirty-five cases （40.23%） had cervical and endometrial neoplasic findings： ten glandular lesions （11.49%） and squamous lesion was present in 25 patients （28.74%）. （2） Among 61 patients with Pap smears subclassified as ＂AGC-not otherwise specified＂, there were 18 pathological abnormalities. Sixteen patients with AGC as ＂favor intraepithelial neoplasia＂ were of 9 pathological abnormalities. Ten patients with AGC as ＂adenocarcinoma in situ＂ or ＂adenocarcinoma＂ were of 6 pathological abnormalities. （3） 100% of patients with AGC had both of colposcopic and cytologic follow-ups： 1 case CIN1, 1 case CIN2 and 1 case CIN3. （4） One of 10 patients was younger than 35 years old with CGIN! and the other 9 patient aged over 35 years old had a greater diversity of glandular lesions. Conclusion A finding of AGC requires both colposcopy and an aggressive workup because of a high rate of cancer and precancerous lesions. The onset of disease is age-related. Women aged over 35 years old has a greater diversity of glandular lesions and account for most cases of cervical and endometrial adenocarcinoma.