阴道管状绒毛状腺瘤临床病理观察

Clinicopathological observation of tubulovillous adenoma of vagina

目的探讨阴道管状绒毛状腺瘤(tubulo-villous adenoma,TVA)的临床病理学特征、免疫表型、鉴别诊断、治疗及预后。方法应用光学显微镜及免疫组织化学方法分析1例阴道TVA病例的临床病理特点及免疫表型,并总结相关文献。结果临床表现为性交后阴道出血,阴道镜下为阴道外生性肿块;HPV16检测为阳性;显微镜下肿瘤呈绒毛管状结构,绒毛中心由纤维血管间质构成,可见间质细胞和炎症细胞;上皮为复层黏液柱状上皮,细胞核椭圆形或长圆形,基本不侵犯深层,神经脉管及周围器官组织。免疫表型:肿瘤细胞villin、CDX2、CEA、CK7、CK20呈阳性,p16呈弥漫强阳性,p53(野生型),SATB-2阴性,Ki67 LI(labeling index,LI)约90%。结论阴道TVA是一种罕见的阴道腺瘤,依据其病理组织学特点诊断不难,该病预后较好,但全球发病量仍较少,制定标准诊断与治疗方法仍需更多的流行病学资料调查。

Objective To explore the clinicopathologic features,immunophenotype,differential diagnosis,treatment and prognosis of vaginal tubulovillous adenoma(TVA).Methods The clinicopathological features and immunophenotype of 1 case of TVA were analyzed by optical micr1 oscopy and immunohistochemistry method,and the related literatures were summarized.Results Its clinical manifestations were vaginal bleeding after a sexual intercourse and vaginal exogenic mass under the Colposcopy.The detection of HPV16 was positive.Microscopically,the tumor showed abundant of tubulovillous architectures with the central fibrovascular axis which contained stroma cells and many inflammatory cells.The epithelium was stratified mucous columnar epithelium.Tumor cell nuclei were oval or oblong,which generally did not invade the deep layers,nerves,vessels and surrounding organs and tissues.Immunophenotype:Villin,CDX2,CEA,CK7 and CK20 were positive in tumor cells.P16 was diffusely and strongly positive in tumor cells.P53 showed wild type.While SATB-2 was negative in tumor cells.Ki67 labeling index was about 90%.Conclusions TVA is a rare kind of adenoma of the vagina,which is not much difficult to differentiate it from other vaginal masses according to its pathological characteristics.TVA usually has a favorable prognosis.However,the incidence of TVA is still low,and more epidemiological data is still required for the development of the standard diagnostic and therapeutic methods.