49例宫颈腺癌临床病理及诊断分析

The clinicopathological and diagnostic analystic in 49 cases cervical adenocarcinom

目的:探讨宫颈腺癌的临床病理特征,分析导致其漏诊和误诊的相关因素,旨在早期确诊和明确组织学分型。方法:回顾性分析2005年1月至2013年12月我院收治的49例宫颈腺癌患者的临床和病理资料,全面梳理各病例的确诊过程。结果:2011-2013年宫颈腺癌占宫颈癌的百分率为20.47%,2005-2007年为10.11%。主要临床症状为阴道流血、流液及白带增多,为非特异性。液基细胞学检查(TCT)假阴性率为28.57%(18/49),高危型HPV检测阳性率为93.88%(46/49),首次活检确诊病例仅为21例(占46.94%)。病理巨检类型以结节息肉状和内生型为主,但呈宫颈炎表现或宫颈光滑者有11例(占22.45%)。组织学类型以黏液腺癌最多见。免疫组织化学CEA、P16和P53呈阳性表达。结论:宫颈腺癌临床症状多为非特异性,综合利用TCT、高危型HPV检测、阴道镜检查、宫颈锥切和免疫组织化学检查等各种诊疗手段,是减少漏诊和误诊的关键。建议把宫颈锥切作为微偏离腺癌、绒毛管状腺癌、宫颈原位腺癌和早期浸润性腺癌的确诊手段。

Objective：To investigate the clinical and pathological features of cervical adenocarcinoma and analyze the relevant factors which leading to misdiagnosis and missed diagnosis, aimed at early diagnosis and afifrm the histological type. Methods：Clinical and pathological data of 49 cases of cervical adenocarcinoma patients, comprehensive combing the treatment and diagnosis process of all cases were retrespeifvely analyzed. Results：The cervical adenocarcinoma percentage of cervical cancer was 20.47%and 10.11%in 2011~2013 and 2005~2007. The main clinical symptoms of cervical adenocarcinoma were vaginal bleeding, fluid flow and increased vaginal discharge. Liquid-based cytology false negative rate was 28.57%（18/49）. High-risk HPV positive rate was 93.88%（46/49）. The ifrst biopsy-conifrmed cases were only 21 cases （46.94%）. The pathology grossly type was mainly about nodular polypoid or endophyte, but that there were 11 cases （22.45%） was cervici-tis or cervical smooth performance. The mucinous adenocarcinoma was the most to see of histology. Immunohis-tochemical CEA, P16 and P53 were positive. Conclusion：The meyority of clinicd syrptoms of the cervical ad-enocarcinama was non-speciifc. Utilization olfiquid-based cytology, high-risk HPV testing, colposcopy, cervical cone biopsy and immunohistochemical examination and other means to effectively master a variety of diagnostic genotyping points is the key to reducing misdiagnosis and miss diagnosis. Suggested that cervical conization as a diagnostic method for the micro-deviation adenocarcinoma, lfuff tubular adenocarcinoma, cervical adenocarci-noma and early invasive adenocarcinoma.