宫颈绒毛腺管状腺癌的临床病理学分析

A clinicopathological analysis on villoglandular adenocarcinoma of the uterine cervix

为探讨宫颈绒毛腺管状腺癌(villoglandular adenocarcinoma,VGA)的临床特征、病理学特征、免疫表型、鉴别诊断、治疗及预后,应用光学显微镜及免疫组织化学方法分析9例VGA病例的临床病理特点及免疫表型,并复习相关文献。9例VGA患者年龄39～62(平均50.8)岁。临床表现多为阴道不规则出血或月经异常,阴道镜下6例为宫颈外生性肿块,3例为宫颈糜烂。HPV检测多为阳性。显微镜下肿瘤具有大量长而细的绒毛状腺管结构,大部分乳头含有中央纤维血管轴心,由梭形间质细胞和多少不等的炎细胞组成;肿瘤细胞低柱状,核圆形,轻中度的细胞异型性,其中7例浸润<1/3纤维肌层。9例VGA中仅1例累及子宫内膜,其余8例均未侵犯神经脉管及周围器官组织。有1例患者部分区域可见原位腺癌成分。免疫表型:肿瘤细胞CEA和p16均呈阳性,不表达Vimentin,少数肿瘤细胞表达ER和PR,Ki-67 LI 30%～90%。VGA是一种少见的宫颈腺癌,难以通过临床表现进行区分,要依据其病理组织学特点,结合免疫组织化学染色明确诊断,该病预后较好,故需谨慎排查防止医疗过度。

To explore the clinicopathologic features, immunophenotype, differential diagnosis, treatment, and prognosis of villoglandular adenocarcinoma (VGA) of the uterine cervix, the clinicopathological features and immunophenotypes of 9 cases of VGA were analyzed by light microscopy and immunohistochemistry, and the related literatures were reviewed. Nine cases of VGA were 39–62 years old, with an average age of 50.8 years. The clinical manifestations were irregular vaginal bleeding or abnormal menstruation. Under colposcopy, 6 cases were cervical exogenic masses and 3 cases were cervical erosion. HPV was mostly positive. Microscopically, we can see abundant of long and thin villoglandular architectures, most papillary architectures contain the central fibrovascular axis, which consists of stroma cells and many inflammatory cells. Tumor cells represent a shape of low column and a round nuclear, with mild to moderate nuclear atypia, of which 7 cases infiltrate less than 1/3 fibromuscular layer. Of the 9 cases of VGA, only one case caused an invasion of endometrium, and the remaining 8 cases did not invaded the nerve, vessel or surrounding organs. Immunophenotype: CEA, p16 were positive in tumor cells, while Vimentin was negative. ER and PR depended on the individuals. Ki-67 index was about 30%– 90%. VGA is a rare adenocarcinoma of the uterine cervix, which is difficult to differentiate it from other cervical adenocarcinoma by clinical manifestations. The diagnosis should be based on its histopathological features and immunohistochemical staining. VGA usually has a favorable prognosis, so it matters to take carefully to avoid the excess of the therapy.