子宫颈复层产黏液上皮内病变四例病理特征分析  

Pathological characteristics of stratified mucin-producing intraepithelial lesions:based on the data of 4 cases

作　　者：戴利 周晓莉[1] 顾文贤[1] 王更芳[1] 程羽青[1] DAI Li;ZHOU Xiao-li;GU Wen-xian;WANG Geng-fang;CHENG Yu-qing(Department of Pathology,Changzhou Second People's Hospital Affiliated to Nanjing Medical University,Changzhou 213164,Jiangsu,CHINA)

机构地区：[1]南京医科大学附属常州市第二人民医院病理科,江苏常州213164

出　　处：《海南医学》2024年第11期1647-1650,共4页Hainan Medical Journal

基　　金：江苏省常州市科技局海外人才专项(编号:CQ20204036);江苏省常州市“十四五”卫生健康高层次人才培养工程项目(编号:2022CZBJ079)。

摘　　要：目的探讨子宫颈复层产黏液上皮内病变(SMILE)的临床病理特征、诊断、鉴别诊断及预后。方法回顾性分析2013-2020年南京医科大学附属常州市第二人民医院收治的4例SMILE患者的临床病理学特征、免疫表型特点及预后情况,并进行相关文献复习。结果4例患者宫颈液基细胞学筛查示3例未见上皮内病变,1例倾向上皮内高度病变的非典型鳞状细胞(ASC-H),3例高危型HPV阳性,1例HPV阴性。巨检均未见占位病变。镜下见细胞排列成复层,可见明显的细胞内黏液,细胞拥挤,排列紊乱,细胞核增大,细胞异型明显,可见核分裂象。1例伴有宫颈高度鳞状上皮内病变(HSIL),1例伴有宫颈原位腺癌(AIS)。免疫组织化学染色显示4例肿瘤细胞P16和Ki-67弥漫强阳性,Cam5.2阳性及P63阴性。4例患者经过宫颈锥切、电切和全子宫切除诊疗,术后随访复查均无复发。结论SMILE是一种罕见的宫颈肿瘤,免疫组织化学染色检测有助于和HSIL、AIS鉴别诊断。Objective To investigate the clinic-opathological features,diagnosis,differential diagnosis,and prognosis of the stratified mucin-producing intraepithelial lesion(SMILE)of the cervix.Methods The clinic-opathological features,immunophenotypic features,and prognosis of 4 cases of SMILE admitted to the Department of Pathology,Changzhou Second People's Hospital Affiliated to Nanjing Medical University from 2013 to 2020 were collected and analyzed,and the related literature was reviewed.Results Liquid-based cytological examination of 4 patients showed that 3 patients had no intraepithelial lesions and malignant transformation and 1 patient had atypical squamous cell with high intraepithelial lesions,and that 3 patients were positive for high-risk HPV and 1 patient was negative for HPV.No mass lesions were found macroscopically.Microscopically,the crowded tumor cells were arranged in multiple layers,with obvious intracellular mucus,disordered arrangement,enlarged nuclei,obvious cell atypia and mitotic figures.One patient had high-grade squamous intraepithelial lesion(HSIL)of cervix,while 1 patient had adenocarcinomas in situ(AIS)of the cervical.Immunohistochemical staining showed that tumour cells were diffusely and strongly positive for P16 and Ki-67 in 4 all cases,positive for Cam5.2,and negative for P63.Four patients underwent cervical conization,electrosurgical excision procedure,and total hysterectomy,and no recurrence was found in the postoperative follow-up.Conclusion SMILE is a rare cervical tumor,and immunohistochemical staining is helpful to differentiate it from HSIL and AIS of the cervical.

关 键 词：复层产黏液上皮内病变 诊断 鉴别诊断 免疫组织化学 

分 类 号：R711.74[医药卫生—妇产科学]