宫颈微小偏离性腺癌临床病理分析

目的 探讨宫颈微小偏离性腺癌(MDA)的临床、病理特征.方法 对2例宫颈微小偏离性腺癌临床资料进行分析,组织化学及免疫组化(S-P法)检测CEA、CK7、CK8、Ki-67、P53,并结合文献进行复习.结果 MDA多见于中老年人,病程6个月至3年不等,预后较差.临床表现主要为白带增多或阴道流水样液,可伴阴道不规则出血.妇检:宫颈肥大,表面糜烂或颗粒状,质硬;宫颈管扩张,可呈桶状.术前临床及病理易误诊为慢性宫颈炎.镜下:MDA分化程度高,瘤组织形态和正常颈管腺体差异微小,腺体结构呈奇异性分支和成角浸润,少见背靠背现象;瘤细胞异型性小,可见个别胞核轻中度增大或核上移,核分裂像无或极少见.浸润深度达宫颈壁的2/3(或7 mm以上),间质可见血管及神经侵犯.可向上侵犯宫腔及淋巴结转移.腺周间质可见不同程度的组织反应及炎细胞浸润.组织化学PAS阳性.免疫组化CEA、CK7、CK8、Ki-67瘤细胞阳性P53蛋白阴性.结论 MDA是一种较为少见的特殊类型的子宫颈腺癌.

The Clinical and Pathological Analysis of Minimal Deviation Adenocarcinoma

Objective To explore the clinical and pathologic features of minimal deviation adenocarcinoma.Methods Analysis of the clinical materials of 2 cases with minimal deviation adenocarcinoma,tests of CEA,CK7,Ki-67,P53 and review of the related documents.Results Minimal deviation adenocarcinoma was common in the middle of life or aged people,the natural course ranged from 6 mouths to 3 years,prognosis was worse.The gynecologic examination: cervical hypertrophy,erosion or granola could be seen in the cervix surface.Texture was hard.Cervical canals were broadened and barrel-shaped.It may be misdiagnosed as chronic cervicitis preoperatively.Under microscope,MDA was highly differentiated,morphous of tumor was similar to that of normal cervical gland.The infiltrated depth may reach 2 thirds of cervical wall(or more than 7mm),Uterine cavity and lymph nodes may be involved upwards.Histochemistry found the PAS was positive.Immunohistochemistry showed that CEA,CK7,CK8,Ki-67 were all positive,P53 was negative.Conclusions MDA is a special kind and rare adenocarcinoma of the uterine cervix.