宫颈高级别腺上皮内瘤变80例临床病理及免疫组织化学观察

Cervical glandular intraepithelial neoplasia：a clinicopathologic and immunohistochemical analysis of80 cases

目的分析宫颈腺上皮肿瘤性病变的临床及病理特征，探讨免疫组织化学在早期宫颈腺癌及癌前病变鉴别诊断中的意义。方法对80例宫颈高级别腺上皮内瘤变（HCGIN）、20例宫颈浸润性腺癌（ICA）以及20例宫颈炎病例进行临床及病理形态分析，并进行p16、Ki-67、癌胚抗原（CEA）、CA125、bcl-2免疫组织化学EnVision法染色。结果HCGIN组临床特征与高级别宫颈鳞状上皮内瘤变（CIN）相似，同时伴C1N者44例（55．0％），伴早期鳞状细胞癌9例（11．3％）。病理形态以原位腺体异形改变为特征。80例HCGIN中p16、CEA、Ki-67的阳性表达比例分别为100．0％、63．8％、73．8％；20例ICA中p16、CEA、Ki-67的阳性表达比例分别为18／20、16／20、20／20；20例宫颈炎中p16、CEA、Ki-67的阳性表达比例分别为1／20、1／20、3／20；p16、CEA、Ki．67在ICA和HCGIN组的表达较宫颈炎组均显著升高（P〈0．01）；Ki-67在ICA组的表达增高，与HCGIN组相比差异有统计学意义（P〈0．05）；CEA在ICA组的表达与HCGIN组相比差异无统计学意义（P〉0．05）。CA125非特异性反应强，bel—2各组腺体阴性或偶有阳性。结论HCGIN易与CIN和鳞状细胞癌伴发，p16、CEA、Ki-67联合检测有助于早期宫颈腺癌及癌前病变的诊断，p16和Ki-67对HCGIN的敏感性高于CEA，CA125和bcl-2对HCGIN的鉴别诊断意义不大。

Objective To assess the clinicopathologic characteristics of cervical glandular intraepithelial neoplasia （CGIN） and to evaluate the usefulness of EnVision immunohistochemistry of various markers in identifying early invasive cervical adenocarcinoma （ICA） and its precursor lesions. Methods Clinical and pathological characteristics of 80 cases of high grade CGIN （HCGIN）, 20 ICA, and 20 cervieitis were reviewed along with immunohistoehemieal studies of p16, Ki-67, CEA, CA125 and bcl-2. Results The clinical features of HCGIN were similar to those of high grade cervical intraepithelial neoplasia （CIN）. Fourty four cases （55.0%） accompanied with CIN and 9 cases （ 11.3% ） accompanied with early cervical squamous cell carcinoma （SCC）. The positive rates of p16, CEA and Ki-67 in 80 cases of HCGIN were 100.0% , 63.8% and 73.8% , respectively. The positive rates of p16, CEA and Ki-67 in 20 ICA were 18/20, 16/20 and 20/20, respectively. The positive rates of p16, CEA and Ki-67 in 20 cervicitis were 1/20, 1/20 and 3/20, respectively. There was a significantly increased expression of p16, CEA and Ki-67 in ICA and HCGIN compared with eervicitis （P 〈 0. 01 ）. Ki-67 expression increased in ICA compared to HCGIN （ P 〈 0. 05 ）. There was no statistical difference in CEA expression between ICA and HCGIN （ P 〉 0. 05 ）. CA125 showed strong but nonspeeific expression. Bcl-2 was negative or occasionally positive in each groups. Conclusions HCGIN is frequently accompanied with CIN and SCC. The combined staining of p16, CEA and Ki-67 provides additional aid in the diagnosis of early stage cervical adenoearcinoma and its precursor lesions. The sensitivity of p16 and Ki-67 markers for HCGIN is higher than that of CEA. CA125 and bcl-2 immunostains offer no helpful in identifying HCGIN.