目的探讨宫颈绒毛腺管状腺癌的临床病理特征、诊断标准及预后。方法分析北京协和医院10例宫颈绒毛腺管状腺癌的临床病理表现,临床资料包括年龄、症状、术前检查、国际妇产科联盟(International Federation of Gynecology Obstetrics,FI...目的探讨宫颈绒毛腺管状腺癌的临床病理特征、诊断标准及预后。方法分析北京协和医院10例宫颈绒毛腺管状腺癌的临床病理表现,临床资料包括年龄、症状、术前检查、国际妇产科联盟(International Federation of Gynecology Obstetrics,FIGO)分期、治疗方式及随访结果,病理表现包括大体表现、颈管浸润程度、有无淋巴结转移及淋巴脉管内瘤栓、组织学分型、核异型性、核分裂及伴随病变。结果 10例患者平均发病年龄为39岁;8例FIGO分期Ib1,1例IIa,1例Ia1;手术方式为全子宫切除+盆腔淋巴结清扫术+双附件切除术/卵巢活检术;术后平均随访29个月,8例健康生存,1例复发,1例失访。大体观察,5例呈息肉样或菜花状外生性肿物,直径5～25mm;4例呈乳头状或细绒毛样粗糙区,面积25mm×14mm至35mm×20mm;1例术后转移病例表现为溃疡型肿物,直径25mm。镜下肿瘤浸润深度2～12mm,浸润宽度5～26mm,1例累及阴道后穹窿;9例有轻-中度核异型性,术后转移1例病例呈中-重度核异型性;核分裂平均48个/10高倍视野(HPF);9例伴有宫颈上皮内瘤变III级(cervical intraepithelial neoplasiaIII,CINIII)和/或原位腺癌(adenocarcinoma in situ,ACIS),2例同时伴有高分化黏液腺癌;1例观察到宫颈壁内个别淋巴脉管内瘤栓。10例均未发现子宫体受累、盆腔淋巴结或卵巢转移。结论宫颈绒毛腺管状腺癌的预后整体较好。提示预后不良的病理指标除了宫颈管壁深层浸润、累及宫体、血管浸润、淋巴结转移外,还包括肿瘤细胞重度异型性和/或合并其他恶性程度更高的肿瘤成分。展开更多
Background:Villoglandular adenocarcinoma of the cervix is a rare neoplasm associated with a favorable outcome.It can be managed conservatively even when complicated by pregnancy.This is the first report in China of vi...Background:Villoglandular adenocarcinoma of the cervix is a rare neoplasm associated with a favorable outcome.It can be managed conservatively even when complicated by pregnancy.This is the first report in China of villoglandular adenocarcinoma complicated with pregnancy.Method of the management was discussed.Case:A privida at 35 weeks gestation was found to have a large,friable,cauliflower like lession.Pathology revealed villoglandular adenocarcinoma.She was dilivered a healthy baby at 36 weeks’ gestation by cesarean section,then a radical hysterectomy and pelvic periaortic lymphadenectomies were performed.The patient remains well at 6 months follow-up.Conclution: villoglandular adenocarcinoma of the cervix has a faverable prognosis and can be managed conservatively,even when coplicated by pregnancy.展开更多
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...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。展开更多
Objective:Villoglandular papillary adenocarcinoma(VGPA)of the uterine cervix is a subtype of cervical adenocarcinoma.In the present study,we summarized the clinical features of VGPA of the uterine cervix and discussed...Objective:Villoglandular papillary adenocarcinoma(VGPA)of the uterine cervix is a subtype of cervical adenocarcinoma.In the present study,we summarized the clinical features of VGPA of the uterine cervix and discussed the potential indications for a conservative treatment.Methods:A retrospective review of clinical characteristics and treatment aspects of 10patients with VGPA at the Obstetrics and Gynecology Hospital of Fudan University was conducted between January 2007 and December 2016.Almost all of the existing 40 English papers on“villoglandular papillary adenocarcinoma[title/abstract]”identified from PubMed were obtained.Clinical data from these papers were analyzed in terms of age,International Federation of Gynecology and Obstetrics(FIGO)stage,recurrence rate,mortality,and conservation treatment aspects.Results:The median age of 10patients with VGPA was 40years.All cases had Stage IB 1 disease.Seven patients underwent human papillomavirus examinations,which revealed 6 positive and 1 negative case(s)of infection.Six patients underwent ThinPrep cytologic tests,which revealed 4patients with atypical glandular cells,1 with a high-grade squamous intraepithelial lesion,and 1 who tested negative for intraepithelial malignancy.None of the patients had lymph node metastases.During the 6-114months of follow-up,no disease recurrence or death occurred.Of note,one patient who received conservative treatment successfully became pregnant.Conclusions:VGPA can be detected at an early FIGO stage with excellent prognosis.For young patients who do not exhibit poor prognosis factors,conservative treatment may be the first treatment choice based on overall assessment of clinical conditions.展开更多
文摘目的探讨宫颈绒毛腺管状腺癌的临床病理特征、诊断标准及预后。方法分析北京协和医院10例宫颈绒毛腺管状腺癌的临床病理表现,临床资料包括年龄、症状、术前检查、国际妇产科联盟(International Federation of Gynecology Obstetrics,FIGO)分期、治疗方式及随访结果,病理表现包括大体表现、颈管浸润程度、有无淋巴结转移及淋巴脉管内瘤栓、组织学分型、核异型性、核分裂及伴随病变。结果 10例患者平均发病年龄为39岁;8例FIGO分期Ib1,1例IIa,1例Ia1;手术方式为全子宫切除+盆腔淋巴结清扫术+双附件切除术/卵巢活检术;术后平均随访29个月,8例健康生存,1例复发,1例失访。大体观察,5例呈息肉样或菜花状外生性肿物,直径5～25mm;4例呈乳头状或细绒毛样粗糙区,面积25mm×14mm至35mm×20mm;1例术后转移病例表现为溃疡型肿物,直径25mm。镜下肿瘤浸润深度2～12mm,浸润宽度5～26mm,1例累及阴道后穹窿;9例有轻-中度核异型性,术后转移1例病例呈中-重度核异型性;核分裂平均48个/10高倍视野(HPF);9例伴有宫颈上皮内瘤变III级(cervical intraepithelial neoplasiaIII,CINIII)和/或原位腺癌(adenocarcinoma in situ,ACIS),2例同时伴有高分化黏液腺癌;1例观察到宫颈壁内个别淋巴脉管内瘤栓。10例均未发现子宫体受累、盆腔淋巴结或卵巢转移。结论宫颈绒毛腺管状腺癌的预后整体较好。提示预后不良的病理指标除了宫颈管壁深层浸润、累及宫体、血管浸润、淋巴结转移外,还包括肿瘤细胞重度异型性和/或合并其他恶性程度更高的肿瘤成分。
文摘Background:Villoglandular adenocarcinoma of the cervix is a rare neoplasm associated with a favorable outcome.It can be managed conservatively even when complicated by pregnancy.This is the first report in China of villoglandular adenocarcinoma complicated with pregnancy.Method of the management was discussed.Case:A privida at 35 weeks gestation was found to have a large,friable,cauliflower like lession.Pathology revealed villoglandular adenocarcinoma.She was dilivered a healthy baby at 36 weeks’ gestation by cesarean section,then a radical hysterectomy and pelvic periaortic lymphadenectomies were performed.The patient remains well at 6 months follow-up.Conclution: villoglandular adenocarcinoma of the cervix has a faverable prognosis and can be managed conservatively,even when coplicated by pregnancy.
文摘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。
文摘Objective:Villoglandular papillary adenocarcinoma(VGPA)of the uterine cervix is a subtype of cervical adenocarcinoma.In the present study,we summarized the clinical features of VGPA of the uterine cervix and discussed the potential indications for a conservative treatment.Methods:A retrospective review of clinical characteristics and treatment aspects of 10patients with VGPA at the Obstetrics and Gynecology Hospital of Fudan University was conducted between January 2007 and December 2016.Almost all of the existing 40 English papers on“villoglandular papillary adenocarcinoma[title/abstract]”identified from PubMed were obtained.Clinical data from these papers were analyzed in terms of age,International Federation of Gynecology and Obstetrics(FIGO)stage,recurrence rate,mortality,and conservation treatment aspects.Results:The median age of 10patients with VGPA was 40years.All cases had Stage IB 1 disease.Seven patients underwent human papillomavirus examinations,which revealed 6 positive and 1 negative case(s)of infection.Six patients underwent ThinPrep cytologic tests,which revealed 4patients with atypical glandular cells,1 with a high-grade squamous intraepithelial lesion,and 1 who tested negative for intraepithelial malignancy.None of the patients had lymph node metastases.During the 6-114months of follow-up,no disease recurrence or death occurred.Of note,one patient who received conservative treatment successfully became pregnant.Conclusions:VGPA can be detected at an early FIGO stage with excellent prognosis.For young patients who do not exhibit poor prognosis factors,conservative treatment may be the first treatment choice based on overall assessment of clinical conditions.
