原发性宫颈腺癌的临床病理及免疫组织化学分析

Clinical pathological analysis and immunohistochemical expression of primary cervical adenocarcinoma in 98 cases

目的 探讨宫颈腺癌的病理分类，免疫组化表达特征，鉴别诊断及预后的因素。方法 对９８ 例原发性宫颈腺癌进行临床病理及免疫组化分析，并与１８ 例子宫内膜腺癌的免疫组化进行比较。其中５４ 例进行了跟踪随访。结果 将本组原发性宫颈腺癌分为５ 类，其中以宫颈内膜型（ｅｎｄｏｃｅｒｖｉｃａｌｔｙｐｅ） 最为常见。免疫组化：癌胚抗原（ＣＥＡ），人乳头瘤病毒１６ 及６Ｂ／１１ 型（ＨＰＶ１６ 及ＨＰＶ６Ｂ／１１）染色的阳性率分别为８３．３％ （１５／１８ 例） ，６６．７％ （６／９ 例） 及５５ ．６ ％ （１０／１８ 例） ，雌激素受体（ＥＲ）及波形蛋白全部阴性表达，增殖细胞核抗原（ＰＣＮＡ）１００ ％ 呈强阳性表达。对照的子宫内膜腺癌ＣＥＡ及波形蛋白染色阳性率为２７．８ ％ （５／１８ 例） 和８３．３％ （１５／１８ 例） ，两型对照差异有显著性。经２ 年随访结果显示宫颈内膜型复发、转移及死亡率较其他各型为高。结论 波形蛋白、ＣＥＡ、ＥＲ 免疫组化染色可作为宫颈腺癌的诊断、鉴别诊断的重要参考依据。ＰＣＮＡ在各型宫颈腺癌中无论分化程度高低均呈强阳性表达，证实即使高分化腺癌仍表现较强的细胞活性。本材料初步证实宫颈腺癌与ＨＰＶ 感染有关。

Objective To discuss the pathological classification, immunohistochemical expression characteristics, differential diagnosis and factors affecting prognosis in cervical adenocarcinoma. Methods Clinical pathological analysis and immunohistochemical study were performed on all primary cervical adenocarcinoma cases (98 patient) from 1991 to 1998. Comparison was made with 18 cases of endometrial adenocarcinoma. 54 cases were followed up. Results These primary cervical adenocarcinoma cases fell into 5 categories, of which the endocervical type being the most common. The positive rate of CEA, HPV16 and HPV6B/11 staining were 15/18 (83.3%), 6/9 (66.7%) and 10/18 (55.6%) cases respectively, while the results of ER and vimentin staining were all negative. PCNA staining was strongly positive in all the cases. In the control group (endometrial adenocarcinoma group) the CEA and vimentin staining positive rates were 27.8% and 83.3% respectively, the difference was significant. The two year follow up indicated that the incidence of recurrence, metastasis and mortality in the endocervical type were higher that those of other types. Conclusion It is difficult to diagnose highly differentiated endocervical adenocarcinoma preoperatively, therefore adequate attention should be attached. Immunohistochemical staining can be used as an important basis for the diagnosis and differential diagnosis of cervical adenocarcinoma. The strongly positive resluts of PCNA staining, regardless of the degree of differentiation, proves that even highly differentiated adenocarcinoma exhibits a high degree of cell activity. Preliminary data suggests that cervical adenocarcinoma is related to HPV infection. Its relation with each HPV subtype remains to be clarified.