宫颈微偏腺癌的临床病理分析

A clinicopathological study on minimal deviation adenocarcinoma of uterine cervix

目的 探讨宫颈微偏腺癌的临床及病理形态特征、诊断要点及有辅助诊断意义的免疫组织化学指标 ,以提高及时诊断的准确性。方法 收集 13例诊断为宫颈微偏腺癌的临床病理资料 ,分析其特征 ,5例作免疫组织化学 (LDP法 )和组织化学 (Foot)染色 (以正常宫颈腺体为对照 ) ;随访其疗效。结果 临床主要表现为水样白带 ,宫颈肥大 ,增粗变硬和糜烂 ,宫旁韧带增厚或硬。病理特征为腺体增生 ,有轻度异型性 ,有向间质浸润的反应 ,或浸至宫颈间质层。癌胚抗原 3+,Ki 6 7+～ 3+,p5 3蛋白 +～ 3+,AB/PAS +或 2 +,Foot染色腺体基底膜部分缺失。结论 诊断宫颈微偏腺癌应结合临床表现 ,指出宫颈腺体有无不典型增生 ,并深取组织 (>5mm)或高频电力锥切宫颈活检 ,可及时诊断 。

Objective Minimal deviation adenocarcinoma(MDA) is frequently underdiagnosed in pathology tests due to its benign histopathological features. Therefore, its clinical and pathological characters need to be further analyzed and to establish useful immunohistochemical markers to improve the accuracy of pathological diagnosis. Methods Clinical pathology data were of 13 MDA cases collected and analyzed in the First and Second Hospitals attached to the University, the pathological characters were compared with matched benign hyperplastic and atypical hyperplastic controls of the glandular epithelial cells to find histochemical and immunohistochemical indices valuable for the pathological diagnosis. 8 of these 13 cases were followed and their conditions were discussed. Results The main clinical symptoms were watery leucorrhagia, enlargement of the cervix with erosion and hardening. Thickened ligaments were also detected in some cases. The pathological findings included hyperplasia and mild abnormality of the glands, invasion effects into the stroma could be observed in some glands and abortive glands with desmoplastic changes, or edema and inflammatory infiltration around the glands were also observed. The invasion presented in the deep part of the cervix as well, some were found near larger blood vessels or in the small vessels. Compared with benign glands, the immunohistochemical indices of most MDA glands were demonstrated as cancer embryo antigen (CEA)+++, Ki-67+～+++, P53+～+++, AB/PAS+/ ++, and focal defect on the basement membrane. Conclusions Once any of the diagnostic characters summarized as above was determined, the probability of MDA should be seriously considered, at least atypical hyperplasia in cervical glands must be diagnosed, and follow-up on the patients and histological biopsy of deep tissues (>5 mm) of the cervix will be necessary to determine the inclusion/exclusion of MDA. Obviously, a correct pathological diagnosis is extremely important for the patient to recieve proper treatment in time and thereby improve her quality of life.