宫颈绒毛腺管状腺癌的临床病理

Clinicopathologic Features of Villoglandular Papillary Adenocarcinoma of the Uterine Cervix

目的探讨宫颈绒毛腺管状腺癌的临床病理特征、诊断标准及预后。方法分析北京协和医院10例宫颈绒毛腺管状腺癌的临床病理表现,临床资料包括年龄、症状、术前检查、国际妇产科联盟(International Federation of Gynecology Obstetrics,FIGO)分期、治疗方式及随访结果,病理表现包括大体表现、颈管浸润程度、有无淋巴结转移及淋巴脉管内瘤栓、组织学分型、核异型性、核分裂及伴随病变。结果 10例患者平均发病年龄为39岁;8例FIGO分期Ib1,1例IIa,1例Ia1;手术方式为全子宫切除+盆腔淋巴结清扫术+双附件切除术/卵巢活检术;术后平均随访29个月,8例健康生存,1例复发,1例失访。大体观察,5例呈息肉样或菜花状外生性肿物,直径5～25mm;4例呈乳头状或细绒毛样粗糙区,面积25mm×14mm至35mm×20mm;1例术后转移病例表现为溃疡型肿物,直径25mm。镜下肿瘤浸润深度2～12mm,浸润宽度5～26mm,1例累及阴道后穹窿;9例有轻-中度核异型性,术后转移1例病例呈中-重度核异型性;核分裂平均48个/10高倍视野(HPF);9例伴有宫颈上皮内瘤变III级(cervical intraepithelial neoplasiaIII,CINIII)和/或原位腺癌(adenocarcinoma in situ,ACIS),2例同时伴有高分化黏液腺癌;1例观察到宫颈壁内个别淋巴脉管内瘤栓。10例均未发现子宫体受累、盆腔淋巴结或卵巢转移。结论宫颈绒毛腺管状腺癌的预后整体较好。提示预后不良的病理指标除了宫颈管壁深层浸润、累及宫体、血管浸润、淋巴结转移外,还包括肿瘤细胞重度异型性和/或合并其他恶性程度更高的肿瘤成分。

Objective To explore the clinicopathologic features, diagnostic criteria, and prognostic factors of villoglandular papillary adenocarcinoma （VGPA） of the uterine cervix. Methods We retrospectively analyzed the clinical and pathological data of l0 VGPA patients including age, clinical stage, surgical proce- dure, outcome, macroscopic features, tumor size, horizontal spread and depth of endophytic tumor, nuclear at- ypicality, mitotic count, lymph capillary space invasion, and lymph node metastasis. Results The median age was 39 years. Eight patients were at stage FIGO Ibl, one at stage IIa, and one at stage Ial. All patients who had undergone hysterectomy and lymphadenectomy were alive, one patient experienced recurrence, and one pa- tient was lost to the follow-up. Macroscopically, 5 cases showed exophytic polypoid or florid lesions with the diameter ranged between 5-25mm, 3 cases showed microvillous rough regions with area ranged between 25 mm×14 mm-35 mm× 20mm, and the recurrent case showed an ulcerative type of mass with the diameter of 25 mm. Horizontal spread and depth of endophytic tumor ranged between 5 -26 mm and between 2 - 12 ram, respec- tively; the invasion of posterior fornix of vagina was observed in one case. All the non-recurrent cases showed mild to moderate cytologic atypia, while the recurrent one showed severe cytologic atypia. The mean mitotic count was 48/10 HPF. Cervical intraepithelial neoplasia （CIN） III and/or acute coronary ischemia syndrome （ACIS） or a mixture of the two were found in 9 cases, 2 of which were simultaneously in association with well- differentiated adenocarcinoma. Occasional lymph capillary space invasion was present in one case. None had corpus infiltration, bulky lymph node metastases, or ovary metastasis. Conclusions VGPA usually has a fa- vorable prognosis. Predictors of a poor outcome include tumor infihration of outer one-third cervical wall, cor- pus infiltration, vascular invasion, and positive lymph nodes; meanwhile, severe cytologic atypia and/or any other more aggressive mafignant tumor can also play a role.