5例宫颈微偏腺癌的临床分析  

Clinical Analysis of Minimal Deviation Adenocarcinoma of the Cervix: A Report of Five Cases

作　　者：常洁[1] 张莘[1] 周晖[1] 梁金晓[1] 林仲秋[1] 

机构地区：[1]中山大学附属第二医院妇瘤科,广东广州510120

出　　处：《癌症》2008年第12期1310-1314,共5页Chinese Journal of Cancer

摘　　要：背景与目的:宫颈微偏腺癌(minimal deviation adenocarcinoma of cervix,MDA)是一种罕见疾病,误诊率较高,尚无规范的治疗方法。本研究旨在分析总结MDA的临床病理特点,以提高对该病的认识。方法:回顾性分析中山大学附属第二医院1991年1月至2006年12月诊治的5例MDA患者的临床病理资料。结果:5例患者的中位年龄47岁(38～59岁)。主要临床表现为大量稀薄粘液性白带、阴道不规则出血等。MDA在组织学上表现为腺体分化好,镜下难与宫颈内膜的正常腺体相区别,但浸润深度超过正常宫颈腺体的深度。免疫组化示2例患者癌胚抗原(CEA)和P53阳性。4例患者接受手术治疗,其中手术+放疗1例,手术+化疗+放疗3例;1例不能手术的患者接受了姑息性放疗。随访6～88个月,无失访病例,2例无瘤生存的患者中有1例无瘤生存时间超过5年,3例死于肿瘤复发转移。结论:MDA的诊断主要依靠临床表现和腺体浸润深度超过正常宫颈腺体深度的病理特点,以手术为主的综合治疗可能是治疗MDA的较好方法。BACKGROUND ＆ OBJECTIVE, The minimal deviation adeno- carcinoma （MDA） of the cervix is a rare disease. The misdiagnosis rate of this disease is relatively high and there is no standard treatment for it. This study was to evaluate clinicopathologic features, diagnosis, and treatment of MDA. METHODS.. Records of five patients with MDA treated in the Second Affiliated Hospital of Sun Yet-sen University from Jan. 1991 to Dec. 2006 were retrospectively analyzed. RESULTS： The median age of the five patients was 47 years （range 38-59 years）. The most common complaints included a large amount of watery discharge and atypical genital bleeding. Histology revealed that MDA was highly differentiated. Although the appearance of MDA glands was difficult to be distinguished from normal endocervical glands, the location of MDA glands was deeper than the lower level of normal endocervical glands. Carcinoembryonic antigen （CEA） and p53 in two patients were detected positive by immunohistochemistry. Four patients underwent surgery, among which one received surgery plus postoperative radiotherapy, and three received surgery plus postoperative chemotherapy and radiotherapy. One inoperable case received palliative radiotherapy. All cases were followed up for 6-88 month. Two patients achieved disease-free survival, one of which survived for more than five years. Three patients died of local recurrence and distant metastasis. CONCLUSIONS Diagnosis of MDA mainly depends on its clinical manifestations and the pathological feature that MDA glands are located deeper than the lower level of normal endocervical glands. Surgery combined with other adjunct therapy achieves good outcomes for MDA.

关 键 词：宫颈肿瘤 微偏腺癌 诊断 治疗 预后 

分 类 号：R737.33[医药卫生—肿瘤]