宫颈绒毛管状腺癌7例临床分析

Villoglandular adenocarcinoma of uterine cervix in 7 cases

目的探讨宫颈绒毛管状腺癌(villoglandular adenocarcinoma of uterine cervix,VGA)的临床特点及预后。方法回顾性分析7例VGA患者的临床资料。结果 7例患者中位年龄为41岁,主要临床表现为接触性阴道出血、阴道不规则出血和白带增多;妇科检查5例可见外生型菜花样赘生物;4例行宫颈液基细胞学检查,其中1例高度可疑腺癌细胞,2例提示为非典型腺细胞(未明确来源),1例为轻-中度炎性反应改变;术前组织病理学检查显示,6例诊断为VGA,1例诊断为宫颈腺癌;FIGO分期ⅠA1期2例,ⅠA2期1例,ⅠB1期2例,ⅠB2期1例,ⅡA期1例;6例行广泛子宫切除+盆腔淋巴结清扫术,1例合并妊娠者行保留生育功能术式;3例术后辅助化疗;术后组织病理结果示7例均符合VGA;4例浅表浸润,2例浅肌层浸润,1例浸润深度2cm;均未见盆腔淋巴结转移;随访5~45个月,未见复发和转移。结论VGA多发于年轻患者,临床表现与常见类型宫颈癌类似,多为外生型,发现时多为早期,浸润深度浅,淋巴结转移少见,预后良好。

Objective To investigate the clinical features and the prognosis of villoglandular adenocarcinoma （VGA） of the uterine cervix. Methods The clinical data of 7 cases of VGA were retrospectively analyzed. Results The median age was 41 years old. The major symptoms were cervical contact bleeding, irregular vaginal hemorrhage and increased leucorrhoea. The gynecological examination showed 5 cases of exogenous florid vegetation. Cervical thinprep liquid cytologic test in 4 cases found highly suspected adenocarcinoma in l cases, atypical adenocyte （undefined） in 2, and mild- moderate inflammatory response changes in 1. Preoperative histopathological examination showed VGA in 6 cases and cervical adenocarcinoma in 1. The International Federation of Gynecology and Obstetrics stage showed I A1 in 2 cases, I A2 in 1, I B1 in 2, I B2 in 1 and II A in 1. Six cases underwent extensive total hysterectomy plus pelvic lymph node dissection and one pregnancy underwent operation preserving fertility. And three of them were given postoperative chemotherapy. The postoperative histopathological results confirmed VGA in all cases. Four cases had superficial infiltration, 2 cases had superficial myometrial invasion, and 1 case had invasive depth of 2 cm. No pelvic lymph node metastasis was found. The follow-up survey for 5 to 45 months showed no relapse or metastasis. Conclusion VGA usually occurs in young patients and its clinical manifestations are similar to other types of cervical cancer. Most of them are exogenous, and they are found in the early stage, with superficial infiltration depth and rare lymph node metastasis. The prognosis is good.