非典型腺细胞在宫颈及子宫内膜病变中的诊断意义

The Diagnostic Significance of Atypical Glandular Cells in Cervical and Endometrial Lesions

目的探讨宫颈非典型腺细胞(atypical glandular cells,AGC)在宫颈及子宫内膜病变中的诊断意义。方法回顾性分析2019年1月至2019年12月南京医科大学附属无锡妇幼保健院病理科细胞学诊断为AGC的74例病例资料,对照相应组织病理学结果进行分析总结。结果宫颈细胞学42438例,其中诊断为AGC 74例,阳性率0.17%。74例AGC中62例有组织学随访结果,良性病变31例(50%),病理组织学结果异常31例(50%):子宫颈低级别鳞状上皮病变(LSIL)12例,子宫颈高级别鳞状上皮病变(HSIL)14例,宫颈腺癌2例,子宫内膜腺癌3例;宫颈病变患者中高危型HPV阳性23例(82.1%),3例子宫内膜病变患者中高危型HPV阳性1例(33.3%),宫颈病变组的HPV阳性率显著高于子宫内膜组(P<0.05);42例年龄<50岁患者中9例为HSIL及以上病变,20例年龄≥50岁患者中10例为HSIL及以上病变,两组比较差异有统计学意义(P<0.05)。结论临床需对AGC患者进行组织病理学检查,细胞学AGC诊断是值得关注和重视的细胞学类别,对于宫颈病变及子宫内膜病变具有一定的提示作用,随诊组织学结果中多数为宫颈鳞状上皮内病变,尤其是高级别鳞状上皮病变累及腺体,可以表现出非典型腺细胞的特点;AGC-倾向瘤变(AGC-favor neoplasia,AGC-FN)组中发生恶性肿瘤的可能性更常见于围绝经期及绝经后女性。

Objective To explore the diagnostic significance of atypical glandular cells(AGC) in cervical and endometrial lesions.Methods A retrospective and follow-up study was conducted in 74 cases of AGC diagnosed at the pathology department of the Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University from January, to December. 2019, and the histological results were compared and analyzed.Results Of 42 438 smears, 74 cases were reported as AGC, with the positive rate of AGC 0.17%. 62 out of 74 cases were further confirmed with histopathological results. Among 62 cases, there were 31 benign changes(50%) and 31 had pathological abnormalities(50%), which included l2 low-grade squamous intraepithelial lesions(LSIL), 14 high-grade squamous intraepithelial lesions(HSIL), 2 cervical adenocarcinoma, 3 endometrial adenocarcinoma. There were 23 patients who were tested positive for high-risk HPV in group of cervical lesions, while one patient tested with high-risk HPV positive in the endometrial lesions group, and the positive rate of HPV was higher in the group of cervical lesions than the endometrial lesions group(P<0.05). 9 of 42 patients aged younger than 50 years old had HSIL and above lesions(21.4%), while 10 of 20 patients aged over 50 years old had HSIL and above lesions(50%), and the difference was statically significant(P<0.05).Conclusion Histopathological examination is needed for patients diagnosed with AGC. AGC has a very positive predictive value in the prediction of cervical and endometrial lesions. The result of follow-up histopathology mostly are cervical squamous intraepithelial lesions, particularly for the HSIL involved glands which can demonstrate AGC features in liquid-based cytology examination. AGC-favor neoplasia(AGC-FN)cytology is more commonly associated with malignancy, especially in the perimenopausal and postmenopausal group.