宫颈腺癌前驱病变的组织学及免疫组织化学观察  

Histopathology and immunohistochemical expression of precursor lesions of cervical adenocarcinoma

作　　者：朱力[1] 李宝珠[1] 

机构地区：[1]北京妇产医院病理科,100006

出　　处：《中华病理学杂志》2001年第4期249-252,共4页Chinese Journal of Pathology

摘　　要：目的　探讨宫颈腺癌前驱病变的诊断和鉴别诊断。方法　对 10 1例病理诊断为宫颈腺癌前驱病变 宫颈腺上皮内肿瘤的标本进行病理形态学观察 ,同时采用免疫组织化学SP法进行癌胚抗原 (CEA)、增殖细胞核抗原 (PCNA)、雌激素受体 (ER)及人乳头瘤病毒 (HPV6/ 11)的检测。结果　病理形态学分级标准根据核染色质的增多、核的异型性及细胞内粘液的数量将宫颈腺上皮内肿瘤分为3级 ,宫颈原位腺癌纳入Ⅲ级宫颈腺上皮内肿瘤中 ,其中 4 6.5 3 % ( 4 7/ 10 1)的病例合并鳞状上皮内病变或宫颈原位癌。免疫组织化学检测结果 :CEA阳性率为 4 4 .5 5 % ( 4 5 / 10 1) ,此外 3 7.62 % ( 3 8/ 10 1)阳性部位表浅 ,仅局限于细胞的顶端及腔缘 ;PCNA强阳性率为 63 .5 4 % ( 61/ 96) ,在Ⅲ级宫颈腺上皮内肿瘤中全部呈强阳性表达 ;ER阳性率为 81.4 8% ( 66/ 81) ,但在部分阳性病例中ER不是均匀分布 ,仅局限阳性 ;HPV6/ 11在Ⅰ～Ⅲ级宫颈腺上皮内肿瘤中的检出率分别为 3 4 .0 9% ( 3 0 / 88)、3 1.82 % ( 2 8/ 88)和 3 .4 1% ( 3 / 88)。结论　宫颈腺上皮内肿瘤的病理组织学分级具有重要的临床意义 ,CEA、PCNA及ER等免疫组织化学表达在诊断及鉴别诊断中具有一定的参考价值。Objective To discuss the histopathology and immunohistochemical expression in precursor lesion of cervical adenocarcinoma cervical intraepithelial glandular neoplasia (CIGN). Methods Histopathological examination and immunohistochemical study (SP method) were performed on 101 cases of CIGN. Results Criteria for histological grading of CIGN into three degrees, grade Ⅰ to Ⅲ, were proposed according to the hyperchromasia and the stratification of nuclei, number of mitoses and the amount of intracellular mucin. Adenocarcinoma in situ was classified as CIGN Ⅲ. 46.53% (47/101) CIGN showed a co existence of CIN (SIL). 45 cases were CEA positive (44.55%) and 38 showed apical and luminal positivity. The positive rate of PCNA was 63.54% and was 100% in CIGN Ⅲ. The positive rate of ER was 81.48% (66/81). The expression of ER was often decreased or missing in certain cases. The positive rate of HPV 6/11 in CIGNⅠ Ⅲ was 34.09% (30/88), 31.82% (28/88), and 3.41% (3/88), respectively. Conclusions Histological grading of CIGN is important. Immunohistochemical staining for CEA?PCNA and ER may be helpful in diagnosis and differential diagnosis of CIGN.

关 键 词：宫颈肿瘤 腺癌 诊断 癌前状态 免疫组织化学 

分 类 号：R737.33[医药卫生—肿瘤]