子宫颈黏液腺癌88例临床病理分析

Study on the clinicopathologic features of 88 cases with mucinous cervical adenocarcinoma

目的探讨宫颈黏液腺癌的临床病理特点，为其诊断、治疗及预后判断提供参考。方法回顾性分析江西省妇幼保健院2003年1月至2007年12月收治的88例宫颈黏液腺癌患者的临床病理资料。结果88例患者中，宫颈管型70例、微小偏离型11例、肠型2例、绒毛管状腺癌5例；I期38例（Ib1期24例、Ib2期14例），Ⅱ期32例（IIa期10例、Ⅱb期22例），Ⅲ期18例（Ⅲa期1例、Ⅲb期17例）。宫颈细胞学检查的阳性率仅为28％（10／36）。10例经反复细胞学检查及宫颈多点活检均未见明显异常的患者，其中7例经宫颈组织大块切除活检及宫颈管搔刮术确诊：5例为宫颈管型，2例为微小偏离型；2例经诊断性锥切确诊：l例为Ib1期宫颈管型腺癌，1例为Ib1期微小偏离型腺癌；1例Ib1期宫颈微小偏离型腺癌患者经宫腔镜下大块组织切除活检确诊。88例患者的总体5年生存率为60．O％，单因素分析显示，患者年龄、临床分期、肿瘤大小、治疗方式与预后有关（P值分别为0．046、0．007、0．007、0．009）；多因素分析显示，仪治疗方式是独立的预后影响因素（P=0．013）。11例宫颈微小偏离型腺癌患者中Ⅱb～Inb期占7／11，而5例宫颈绒毛管状腺癌患者中1Ib-Ⅲb期仅1例。88例患者总体HPV感染率为65％（57／88），不同病理类型宫颈黏液腺癌的HPV感染率比较无明显差异。结论宫颈细胞学检查对宫颈黏液腺癌的诊断意义不大；宫颈黏液腺癌早期容易漏诊，尤其是宫颈微小偏离型腺癌，宫颈组织大块切除活检、宫颈管搔刮术、诊断性锥切及宫腔镜检查有助于其诊断。治疗方式是影响宫颈黏液腺癌预后的重要因素。

Objective To analyze the clinicopathologic features of mutinous cervical adenocarcinoma （ADC） and supply some reference for its diagnosis, treatment and prognosis. Methods Totally 88 cases with primary mucinous ADC diagnosed between January 2003 and December 2007 in Jiangxi Maternal and Child Health Hospital were retrieved. Their clinical and pathological data were reviewed and analyzed. Results Among 88 patients, 70 cases of them were endocervical ADC, 11 cases were minimal deviation adenocarcinoma （MDA） , 2 cases were intestinal subtype and 5 cases were villoglandular ADC. The positive rate of cervical Pap smear cytology was only 28% （10/36）. There were 10 cases were performed several times of e.ervical Pap smear cytology test and biopsies, while still no abnormality was found. Finally, 7 cases of them were diagnosed by cervical excisional biopsy and endocervical curettage, including 5 cases with endocervical ADC and 2 cases with MDA; 2 cases （1 case with stage [ bl endocervical ADC and 1 case with I bl MDA） were diagnosed by cold knife conization, and 1 case with stage I bl endocervical were diagnosed by uteroscopically directed biopsy. The overall 5-year survival rate was 60. 0%. Using univariate analysis results showed that age （ P = 0. 046） , stage （P = 0. 007 ） , tumor size （ P = 0. 007 ） and therapeutic methods （ P = 0. 009 ） were significant prognostic factors. Multivariate analysis showed that therapeutic methods was an independent predictor for survival （ P = 0. 013 ）. Stage. b - m b MDA patients occupied 7/11 of all MDA patient, while there was only one such patie＇t of 5 cases with villoglandular ADC. The overall HPV infection rate was 65% （57/88）, and there was no obvious differences about the HPV infection rates among different types of mucinous ADC. Conclusions Cervical smear cytology is of little significance to the diagnosis of mucinous cervical adenocarcinoma. Early stage mucinous ADC is difficuh to be detected, especially for MDA. Cervical excisional biopsy, endocervical curettage, cold knife conization, uteroscope are beneficial to its diagnosis. Therapeutic methods is an important prognostic factor for mucinous ADC and comprehensive treatment should be given to those patients with risky postsurgical factors.