宫颈原位腺癌的病理学特征分析  

Clinicopathological features of cervical adenocarcinoma in situ

作　　者：李松梅[1] 黄述斌[1] 王志强[1] 徐亮[1] 方伟[1] 

机构地区：[1]池州市人民医院病理科,安徽池州247000

出　　处：《西部医学》2018年第1期27-30,34,共5页Medical Journal of West China

摘　　要：目的探讨宫颈原位腺癌(adenocarcinoma in situ,AIS)的临床病理学特征,为临床诊断及治疗提供依据。方法收集11例宫颈腺体病变进行光镜观察及免疫组化染色观察并分析临床病例资料。结果 11例病例中4例伴有高级别鳞状上皮病变(High grade squamous intraepithelial lesion,HSIL),2例伴有子宫肌瘤,1例伴有右卵巢子宫内膜异位囊肿。临床上有接触性出血、白带增多、发现赘生物、月经淋漓不净或无症状,临床采用loop electrosurgical excision(Leep)术、全子宫切除或全子宫及更大范围切除。光镜下宫颈部分腺上皮呈复层或假复层异型增生伴核分裂增多,凋亡小体均可见,局灶或弥漫多灶分布,病变上皮与宫颈腺上皮有移行。免疫组化示病变上皮p16弥漫胞浆和胞核强阳性,与阴性宫颈腺上皮形成明显对照,ki-67阳性占60%~90%。结论宫颈原位腺癌是非常少见的宫颈腺上皮原位病变,结合临床病理学特征、免疫表型有助于诊断及鉴别诊断,临床治疗建议行宫颈锥切等保守治疗,尤其是要保留生育功能的年轻患者,术后要进行密切随访。Objective To study the clinicopathologic features of cervical adenocarcinoma in situ （AIS）. Methods The microscopic and immunohistochemical features were examined in 11 cases of AIS. Results The patients’ ages ranged from 29 to 55 years, with a median age of 43 years. 9 patients presented with symptom, including increased leucorrhea, touched bleeding and hyper menorrhea. 2 patients were asymptomatic. Patients were treated with loop electrosurgical excision or hysterectomy. The epithelium of endocervix was replaced by atypical columnar or stratified epithelium. Mitotic figures and apoptonic bodies were present. High grade squamous intraepithelial lesion （HSIL） was appreciated in 4 cases. AIS showed strong, diffuse reaction for p16 by contrast with glandular epithelium. Ki67 expression increased compared with cervical glands. Conclusion AIS is a rare lesion of endocervix. Its diagnosis and differential diagnosis must be established on the clinicopathologic features and immunohistochemical findings. Conservative management with conization and careful surveillance is suitable for patients with AIS and desire for future childbearing.

关 键 词：宫颈原位腺癌 免疫组织化学 P16 KI-67 

分 类 号：R737.33[医药卫生—肿瘤]