宫颈原位腺癌28例临床病理观察  

Adenocarcinoms in situ of the cervical:a clinicolpathological study of 28 cases

作　　者：唐曼[1] 王晴 张和平[1] 赵彩霞[1] 陈勇[1] 娄蓉 TANG Man;WANG Qing;ZHANG Heping;ZHAO Caixia;CHEN Yong;LOU Rong(Department of Pathology,Anhui Women and Clild Health Care Hospital(Women and Child Health Care Affiliated Hospital of Anhui Medical University),Hefei,Anhui 230001,China)

机构地区：[1]安徽省妇幼保健院(安徽医科大学附属妇幼保健院)病理科,安徽合肥230001

出　　处：《安徽医药》2022年第7期1394-1397,I0004,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的 探讨宫颈原位腺癌(adenocarcinoma in situ,AIS)的临床病理特征、免疫表型、鉴别诊断、治疗及预后。方法 按照第四版WHO女性生殖器官肿瘤分类标准对2009年1月至2016年5月安徽省妇幼保健院28例诊断为宫颈原位腺癌的病例进行重新分类,分析其临床病理学特征并采用免疫组织化学Envision法检测细胞周期蛋白依赖性激酶抑制剂(p16)、癌胚抗原(CEA)、肿瘤增殖抗原(Ki-67)在其组织中的表达。结果 病人年龄范围26~54岁,中位年龄39.5岁;临床表现为阴道不规则流血46.4%(13例),接触性出血28.6%(8例),阴道排液3.5%(1例),其余6例无明显临床症状;所有病例均先行宫颈活检或宫颈锥切术,组织学特征24例AIS为宫颈内膜型,镜下与正常宫颈黏液上皮相似,上皮空泡状,具有颗粒状胞质,细胞核增大,染色质粗糙,腔缘可见核分裂象和凋亡小体;3例AIS为肠型,上皮出现类似于肠上皮的杯状细胞,胞质有大量黏液,位于细胞一侧,局部区域混合有宫颈内膜型AIS;1例为复层产生黏液的上皮内病变(SMILE),复层上皮的所有细胞都含有黏液空泡,细胞核有异型性,染色质浓染,核分裂象可见;28例AIS,17例(60.7%)伴有宫颈鳞状上皮内病变,其中2例伴低级别鳞状上皮内病变,15例伴高级别鳞状上皮内病变。免疫表型:p16、CEA在原位腺癌中的阳性率分别为96.4%(27/28),85.7%(24/28),Ki-67增殖指数为40%~80%。28例中17例行单纯子宫切除术,11例行宫颈锥切术,4例锥切后切缘阳性。23例获得随访,中位随访时间41.5个月,4例复发,其中2例为切缘阳性,复发后病理仍为宫颈原位腺癌,另2例复发为浸润性腺癌,后行全子宫双附件及盆腔淋巴结清扫术,1例术后13个月死亡,1例术后8个月无瘤生存。结论 宫颈AIS具有特殊的形态学特征,常伴发宫颈鳞状上皮内病变,容易造成病变漏、误诊,p16、CEA、Ki-67联合使用有助于AIS的诊断,宫颈AIS的治疗首先应行宫颈锥�Objective nosis of the adenocarcinoma in situ(AIS) of the cervix.Methods Twenty-eight cases of cervical AIS diagnosed in Anhui Maternal and Child Health Hospital from January 2009 to May 2016 were reclassified according to the fourth edition of WHO classification criteria for tumors of female genital organs.The clinicopathological features were analyzed,and the expression of cyclin-dependent kinase inhibitor(P16),carcinoembryonic antigen(CEA),and tumor proliferation antigen(Ki-67) protein in the tissues was detected by immunohistochemistry.Results manifestations were 46.4 %(13 cases) of irregular vaginal bleeding,28.6 %(8 cases) of contact bleeding,3.5 %(1 case) of vaginal discharge,and the remaining 6 cases had no obvious clinical symptoms.All patients underwent cervical biopsy or cervical conization,and the histological characteristics of 24 cases of AIS were cervical endometrial type,AIS was similar to normal cervical mucinous epithelium under microscope,the epithelium was vacuolated,with granular cytoplasm,enlarged nucleus,rough chromatin,mitosis and apoptotic bodies at the edge of the cavity;3 cases were intestinal type,goblet cells similar to intestinal epithelium appeared in the epithelium,there was a large amount of mucus in the cytoplasm,which was located on one side of the cells,and mixed with cervical endometrial type AIS in local area.1 case was stratified mucin-producting intraepithelial lesion(SMILE),in which all the cells in the stratified epithelium contained mucinous vacuoles,nuclear atypia,chromatin staining and mitosis.Of the 28 AIS cases,17(60.7 %) had cervical squamous cell lesions,including 2 cases were LSIL,and other 15 cases were HSIL.Immunophenotype:the positive rates of p16 and CEA in adenocarcinoma in situ were 96.4 %(27/28),85.7 %(24/28),and proliferation index of Ki-67 was 40 to 80 %.All patients underwent surgery with different methods,17 cases were treated by hysterectomy,11 cases were treated by conizationa,and 4 cases had positive cutting edge after conization.23 cases of them wer

关 键 词：宫颈肿瘤 腺癌 阴道镜检查 宫颈锥切术 免疫组织化学 

分 类 号：R737.33[医药卫生—肿瘤]