宫颈复层产黏液上皮内病变的细胞学特点及诊断探讨  

Cytological features and diagnosis of stratified mucin-producing intraepithelial lesions of the cervix

作　　者：唐福婷 章宜芬[1] 徐慧[1] TANG Fu-ting;ZHANG Yi-fen;XU Hui(Department of Pathology,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]江苏省中医院病理科,南京210029

出　　处：《诊断病理学杂志》2025年第3期239-243,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨宫颈复层产黏液上皮内病变(SMILE)的细胞学特点及诊断方法。方法回顾性分析10例SMILE患者的临床资料、宫颈液基薄层细胞涂片(TCT),组织病理切片,其中5例利用剩余液基细胞学样本制作细胞蜡块并行免疫及特殊染色。结果液基细胞学中,SMILE排列成团,细胞团边缘部分呈锯齿状、部分光滑,周围可见富含黏液空泡的不规则柱状细胞;大部分细胞核明显增大呈类圆形,细胞核排列拥挤、紊乱、极性消失;核质比明显增高;染色质略深染、粗糙,未见明显核仁。细胞蜡块中见片状的复层细胞团,细胞核中度异型,未见核仁,细胞核之间存在胞质空隙,p16强阳性表达,p40边缘细胞阳性表达,Ki-67增高,特殊染色可见黏液。无一例液基细胞学诊断为SMILE,4/5例细胞蜡块诊断出SMILE,两者比较,P<0.05,差异具有统计学意义。结论TCT细胞学特点不特异,诊断SMILE困难,细胞蜡块技术有助于细胞学SMILE的诊断,为临床管理助力。Objective To investigate the cytological features and diagnosis of stratified mucin-producing intraepithelial lesions(SMILE)of the cervix.Methods The clinical data,ThinPrep liquid-based cytology test(LCT)of 10 SMILE patients,the slices of cell block of remaining sample of liquid-based cytology of 5 cases with immunophenotype and special staining,and postoperative histopathologic sections of them were retrospectively analyzed,and related literatures were reviewed.Results The cell clusters of SMILE in TCT demonstrated jagged outlines with smooth border locally.Irregular columnar cells with rich mucous vacuoles were observed around the border of cell clusters.The cells were crowded and disordered,most of nuclei were significantly enlarged.The nuclei were round with inconspicuous nucleoli and coarse chromatin,which showed moderately hyperchromic.In the cell block ssections,the cells arranged in stratified layers,in which cytoplasmic spaces was observed,and the nuclei were moderately atypia.Immunocytochemistrically,p16 was strongly positive,p40 highlighted the edge cells,Ki-67 proliferation index increased,and mucus staining was positive.None of the patients were diagnosed as SMILE by TCT,and 4/5 were diagnosed as SMILE by cell block,the difference was statistically significant(P<0.05).Conclusion SMILE is relatively subtle atypical cytological features,and so it is difficult to diagnose with TCT.It can help to diagnose SMILEs with cell blocks combined with immunocytochemistry and mucus staining and to facilitate clinical management.

关 键 词：复层产黏液上皮内病变 细胞学 宫颈 诊断方法 液基细胞学 

分 类 号：R737.33[医药卫生—肿瘤]