13例子宫颈胃型腺癌漏诊误诊分析

Analysis of missed diagnosis and misdiagnosis of 13 cases with gastric-type endocervical adenocarcinoma

目的分析子宫颈胃型腺癌(gastric-type endocervical adenocarcinoma,G-EAC)临床特征、诊断经过,总结漏诊及误诊原因,为疾病早期诊断提供帮助。方法回顾性分析湖北省妇幼保健院2016年12月至2023年2月经病理确诊并且存在漏诊误诊的13例G-EAC患者的基本病例资料,总结漏诊及误诊原因。结果有阴道流液8例(61.5%),阴道出血表现4例(30.8%),以B超发现宫颈管异常回声表现1例;9例宫颈外观正常(69.2%),3例宫颈菜花样,1例宫颈肿物。9例行HPV检测,均为阴性;9例行TCT检查,6例(66.7%)异常。7例行肿瘤标志物检查,4例(57.1%)CA199升高,4例(57.1%)CA125升高,3例(42.9%)癌胚抗原(carcinoembryonic antigen,CEA)升高。13例行盆腔超声检查,5例(38.5%)宫颈回声改变;10例行MRI检查,7例(70.0%)提示宫颈恶性肿瘤。初步诊断误诊为阴道炎7例(53.8%),卵巢囊肿1例,痔疮2例,异常子宫出血2例,宫颈息肉1例,延迟诊断时间为5天~3年。最终经宫颈活检或诊刮确诊9例(69.2%),4例(30.8%)在术后病理确诊。5例随访4~34月死亡,7例随访1~24月存活,1例住院中。结论G-EAC少见,临床表现不典型,组织分化好,容易漏诊、误诊,临床医生需加强对该病认识,重视患者主诉及妇科超声检查,对可疑患者行肿瘤标志物检测,积极行宫颈多点活检甚至宫颈锥切术;病理科医生需要提高对该疾病认识,重视免疫组织化学检查,提高诊断率。

Objective To analyze the clinical features and diagnostic history of gastric-type endocervical adenocarcinoma(G-EAC),summarize the causes of missed diagnosis and misdiagnosis,and provide help for early diagnosis of the disease.Methods The basic case data of 13 G-EAC patients diagnosed by pathology and with missed diagnosis and misdiagnosis in Maternal and Child Health Hospital of Hubei Province from December 2016 to February 2023 were collected for retrospective analysis,and the causes of missed diagnosis and misdiagnosis were summarized.Results There were 8 cases(61.5%)with vaginal discharge,4 cases(30.8%)with vaginal bleeding,and 1 case with abnormal echogenicity of the cervical canal detected by ultrasound;9 cases(69.2%)had normal cervical appearance,3 cases had cauliflower-like cervix,and 1 case had cervical mass.HPV test was performed in 9 patients and the results were all negative;TCT was performed in 9 patients,6 of them(66.7%)were abnormal.7 cases were examined by tumor markers,CA199 was elevated in 4 cases(57.1%),CA125 was elevated in 4 cases(57.1%),and carcinoembryonic antigen(CEA)was elevated in 3 cases(42.9%).Cervical echo was changed in 5 cases(38.5%)of 13 cases undergoing pelvic ultrasound;MRI was performed in 10 patients,and 7 of them(70.0%)suggested cervical malignancy.The initial diagnosis was misdiagnosed as vaginitis in 7 cases(53.8%),ovarian cyst in 1 case,hemorrhoids in 2 cases,abnormal uterine bleeding in 2 cases,and cervical polyp in 1 case,with a delayed diagnosis time of 5 days to 3 years.The final diagnosis was confirmed by cervical biopsy or diagnostic scraping in 9 cases(69.2%),and 4 cases(30.8%)were confirmed by postoperative pathology.5 cases died from 4 to 34 months of follow-up,7 cases survived from 1 to 24 months of follow-up,and 1 case was in hospital.Conclusion G-EAC is rare clinically and has atypical symptoms and well differentiated tissues,so it is easy to be missed and misdiagnosed.Clinicians need to enhance their knowledge of the disease,pay attention to patients'complaints and gynecologic ultrasound examinations,tumor marker were detected in suspicious patients,and actively perform multi-point cervical biopsy or even cervical conization;pathologists need to enhance their knowledge of the disease and pay attention to immunohistochemical examinations to improve the diagnosis rate.