子宫颈微偏腺癌4例临床病理分析

目的探讨子宫颈微偏腺癌(minimal deviation adenocarcinoma, MDA)的临床病理学特征、免疫表型、诊断及鉴别诊断。方法回顾性分析4例子宫颈MDA的临床病理资料,行HE及免疫组化EnVision法染色,并复习相关文献。结果 4例患者平均年龄42岁,临床均出现子宫颈肥大;3例行根治性手术+放疗,1例行活检+放疗+化疗;镜下肿瘤由黏液性腺体构成,腺体和细胞分化良好,呈浸润性生长,超出正常子宫颈腺体分布范围,间质反应明显;免疫表型:MUC6、CK7、CEA、p53均阳性,Ki-67增殖指数10%～30%,p16、ER、PR均阴性。术后随访12～40个月,2例出现转移,其余2例未见复发和转移。结论子宫颈MDA临床罕见,属于分化极好的胃型黏液腺癌。因缺乏特异性的临床症状、体征及辅助检查,常导致误、漏诊。结合组织学形态和免疫组化可明确诊断。     

子宫颈微偏腺癌临床病理分析

子宫颈微偏腺癌（minimal deviation adenocarcinoma,MDAC）是女性生殖系统极少见的肿瘤,由于其分化程度很高。细胞形态常与子宫颈黏液腺上皮细胞相似,往往造成活检时的漏诊。现报道4例子宫颈MDAC,对其临床病理形态学、组织化学和免疫表型特征进行观察分析,并探讨其诊断和鉴别诊断。     

子宫颈微偏腺癌6例临床病理分析

目的探讨子宫颈微偏腺癌的形态学、组织化学及免疫表型特征。方法对6例子宫颈微偏腺癌组织学特征进行观察,并行黏液组化及免疫组化染色（S-P法）。结果6例均有子宫颈腺体显著增生,腺体腔缘面呈花边状、锯齿状或乳头状突入到腺管腔内,并有成角状外翻,腺体呈浸润性生长。黏液组织化学：AB（pH1．0、2．5）／PAS染色证实,腺体腔内为混合性黏液,主要含唾液酸黏液,硫酸黏液减少,中性黏液较多。免疫表型：CEA（5／6）阳性,CA125（6／6）阴性。vimentin、SMA浸润性腺体周围纤维母细胞／肌纤维母细胞（6／6）阳性。结论子宫颈微偏腺癌以其特殊的形态结构和细胞轻微的异型、AB／PAS阳性、CEA阳性及腺体周围反应性纤维母细胞／肌纤维母细胞增生为特征。     

子宫颈黏液腺癌21例病理诊断分析

目的 对子宫颈黏液腺癌病理诊断过程的分析旨在为早期诊断、减少漏诊总结经验.方法 回顾性分析21例子宫颈黏液腺癌的病理诊断过程;采用LABC法免疫组化检测CEA及Ki-67的表达.结果 21例子宫颈黏液腺癌诊断中,漏诊3例(14.3%),其中1例为TCT漏诊,2例为子宫颈活检漏诊;4例(19.0%)子宫颈活检诊断为子宫颈原位腺癌、浸润不能除外,后经LEEP术确诊为子宫颈浸润性黏液腺癌;1例(4.8%)子宫颈活检诊断为慢性子宫颈炎,经LEEP术确诊为子宫颈浸润性黏液腺癌;12例(57.1%)直接由子宫颈活检确诊为子宫颈黏液腺癌;1例(4.8%)经诊刮诊断为腺癌,无法确定组织学类型,术后确诊为子宫颈黏液腺癌.免疫组化染色显示,其中10例CEA表达阳性(47.6%),Ki-67表达均升高(>20%).结论 从细胞学及组织形态学上,掌握子宫颈黏液腺癌的诊断要点,可以减少漏诊,及早做出正确的诊断,为患者赢得宝贵的手术时间.     

宫颈微偏腺癌的临床病理分析

目的探讨宫颈微偏腺癌的临床及病理形态特征、诊断要点及有辅助诊断意义的免疫组织化学指标,以提高及时诊断的准确性.方法收集13例诊断为宫颈微偏腺癌的临床病理资料,分析其特征,5例作免疫组织化学(LDP法)和组织化学(Foot)染色(以正常宫颈腺体为对照);随访其疗效.结果临床主要表现为水样白带,宫颈肥大,增粗变硬和糜烂,宫旁韧带增厚或硬.病理特征为腺体增生,有轻度异型性,有向间质浸润的反应,或浸至宫颈间质层.癌胚抗原3+,Ki-67+～3+,p53蛋白+～3+,AB/PAS+或2+,Foot染色腺体基底膜部分缺失.结论诊断宫颈微偏腺癌应结合临床表现,指出宫颈腺体有无不典型增生,并深取组织(>5 mm)或高频电力锥切宫颈活检,可及时诊断,防止漏诊.     

子宫颈原位腺癌65例临床病理分析

目的 探讨子宫颈原位腺癌(adenocarcinoma in situ,AIS)的临床病理学特征.方法 回顾性分析65例子宫颈AIS的临床表现、HPV类型、细胞学结果、手术方式及术后病理学特征.结果 患者中位年龄38岁,年龄以30～39岁居多;41％患者有阴道流血、白带异常及阴道排液等症状,59％患者无临床表现;HPV...     

子宫颈微偏腺癌4例临床病理分析

目的探讨子宫颈微偏腺癌(minimal deviation adenocarcinoma, MDA)的临床及病理形态学特点、免疫表型特征,以期提高疾病的早期诊断与治疗。方法对4例MDA进行临床病理学分析及免疫组化染色,并复习相关文献。结果 4例患者均为女性,年龄40～55岁,平均46.5岁。临床表现为阴道水样或黄绿色浓稠样排液及不规则出血。征象为子宫颈肥大。1例B超示:子宫颈囊肿。阴道镜检查均示:子宫颈性状改变,见异型血管。HPV均阴性,TCT无异常。镜下可见分化较好的腺体,生长方式杂乱无序,并向深层浸润,腺体周围可见促结缔组织增生性间质反应。核异型性不明显,位于上皮细胞基底部,核分裂象可见。子宫颈深部腺体邻近厚壁血管或淋巴管。免疫表型:4例MUC6均(+),3例CEA(+),ER、PR、p16均(-),2例p53(+),1例CA125(+),Ki-67增殖指数10%～30%。结论 MDA是子宫颈腺癌的一种罕见的高度分化型,病理医师在诊断时应与临床进行多学科讨论,充分考虑患者病史,对于存在阴道大量排液,子宫颈肥大,组织学表现为胃型黏液性癌的患者,要警惕MDA的可能。     

子宫颈上皮病变18304例临床病理分析

目的通过对新疆医科大学附属肿瘤医院18304例不同时期、不同年龄段、不同民族之间子宫颈癌、子宫颈上皮内瘤变(cervical intraepithelia lneoplasia,CIN)的检出率分析,了解其发病状况的变化。方法对1989～2009年间18304例子宫颈上皮病变组织病理学检查结果及患者的年龄、民族分布进行回顾性分析。结果 (1)子宫颈癌共检出5891例,55～64岁年龄段检出率最高(51.71%),其中维吾尔族检出4440例(75.37%);子宫颈癌检出率呈逐渐下降趋势(57.73%→18.78%)。(2)CIN共检出2601例,CIN1和CIN2～3分别在30～34岁、35～39岁年龄段检出率最高(6.11%,14.25%),平均年龄有年轻化趋势(P0.01);汉族共检出1745例(67.09%);检出率呈逐渐上升趋势(CIN11.20%→6.72%,CIN2～33.50%→13.26%)。(3)子宫颈癌病理类型以中分化鳞状细胞癌为主(66.13%),其中维吾尔族2957例(75.90%)。结论 (1)子宫颈癌的检出率呈逐年下降趋势,55～64岁年龄段检出率最高,其中维吾尔族最多。(2)CIN的检出率呈逐年上升趋势,30～39岁年龄段检出率最高,平均年龄有年轻化趋势,汉族最多。(3)子宫颈癌病理类型以中分化鳞状细胞癌为主,维吾尔族最多。     

宫颈微偏腺癌六例伴五例卵巢转移的临床病理学分析

目的:探讨宫颈微偏腺癌（minimal deviation adenocarcinoma of cervix,MDA）伴卵巢转移临床病理特征。方法:收集四川省肿瘤医院2014年1月至2019年12月确诊MDA 6例伴卵巢转移5例,总结其临床病理特点及HER2表达状况,并结合文献复习。结果:6例患者年龄33~71岁,中位...     

Well-differentiated adenocarcinoma of the gallbladder mimicking minimal deviation adenocarcinoma of the cervix

We report a case of well-differentiated adenocarcinoma of the gallbladder, histologically mimicking minimal deviation adenocarcinoma (MDA) of the cervix. A 71-year-old Japanese male underwent cholecystectomy because of the suggestion of gallbladder carcinoma. The resected gallbladder showed a localized thickening of the gallbladder wall with a polypoid lesion measuring 12x7 mm in diameter. Microscopically, the polypoid lesion proved to be a well-differentiated adenocarcinoma composed of columnar cells with a clear cytoplasm. In the thickened gallbladder wall, well-formed glands were extensively distributed; they were surrounded by a slightly desmoplastic reaction instead of lamina propria, or were directly in contact with smooth muscle cells. The diagnostic criteria for cervical MDA may be useful in distinguishing well-differentiated adenocarcinoma of the gallbladder from benign conditions, such as Rokitansky-Aschoff sinus and adenomyomatosis. It is remarkable that the tumor cells of the present case expressed gastric type mucin which is characteristic of mucinous type cervical MDA.     

The spectrum of minimal deviation melanoma: a clinicopathologic study of 21 cases

A retrospective study of 21 patients with the histopathologic diagnosis of minimal deviation melanoma (MDM; n = 18) and borderline melanoma (BM; n = 3) was undertaken to determine the prognosis for these patients compared with that for patients with other types of malignant melanoma. The findings indicate that the prognosis for these uncommon nevomelanocytic tumors is somewhat better than that for other malignant melanomas. Follow-up periods in this series ranged from 18 to 96 months (mean, 57 months). Primary lesions ranged in thickness from 1.6 to 10.4 mm. The histopathologic subtypes included the Spitz variant (nine patients), the spindle cell variant (six patients), the combined spindle and epithelioid cell type (three patients), and the small epithelioid cell type (three patients). Only two of the patients died of widespread metastatic disease. Comparison of the histologic and clinical prognostic indicators of mortality in patients who have malignant melanoma with the clinical and pathologic features seen in this series of 21 patients would appear to indicate a diminished tendency toward metastatic or recurrent disease in patients with MDM and BM.     

Diagnosis of adenocarcinoma in prostate needle biopsy tissue

Prostate cancer is a major public health problem throughout the developed world. For patients with clinically localised prostate cancer, the diagnosis is typically established by histopathological examination of prostate needle biopsy samples. Major and minor criteria are used to establish the diagnosis, based on the microscopic appearance of slides stained using haematoxylin and eosin. Major criteria include an infiltrative glandular growth pattern, an absence of basal cells and nuclear atypia in the form of nucleomegaly and nucleolomegaly. In difficult cases, basal cell absence may be confirmed by immunohistochemical stains for high-molecular-weight cytokeratins (marked with antibody 34betaE12) or p63, which are basal cell markers. Minor criteria include intraluminal wispy blue mucin, pink amorphous secretions, mitotic figures, intraluminal crystalloids, adjacent high-grade prostatic intraepithelial neoplasia, amphophilic cytoplasm and nuclear hyperchromasia. Another useful diagnostic marker detectable by immunohistochemistry is alpha-methylacyl coenzyme A racemase (AMACR), an enzyme selectively expressed in neoplastic glandular epithelium. Cocktails of antibodies directed against basal cell markers and AMACR are particularly useful in evaluating small foci of atypical glands, and in substantiating a diagnosis of a minimal adenocarcinoma. Reporting of adenocarcinoma in needle biopsy specimens should always include the Gleason grade and measures of tumour extent in the needle core tissue. Measures of tumour extent are (1) number of cores positive for cancer in the number of cores examined, (2) percentage of needle core tissue affected by carcinoma and (3) linear millimetres of carcinoma present.     

A clinicopathological and immunohistochemical study of minimal deviation adenocarcinoma of the uterine cervix

Objective

To investigate the clinical, pathological and immunohistochemical features of minimal deviation adenocarcinoma (MDA) of the uterine cervix by conducting a retrospective study of 25 cases consecutively treated in three institutes over a 10 years period.

Methods

Of 25 cases with MDA, clinical features were retrospectively reviewed, gross and micro appearances of surgical specimens of 17 operative cases were observed. Ki67, SMA, p53, PCNA, Vimentin, CEA, ER, CA125 and PR were detected on tissues from MDA and 50 cases common adenocarcinomas of the uterine cervix (AUCs) (differentiation rank: high 16, moderate 20, low 14). Their expressions were assessed in paraffin sections using the immunohistochemistry method.

Results

MDA accounted for only 1.2% of adenocarcinomas of the uterine cervix. The main clinical manifestations were vaginal profuse, watery or mucoid discharge and irregular bleeding. Signs were cervical hypertrophy or thickening. The gross appearance showed many similarities with common AUCs. Immunohistochemical results: the positive rates for p53 and Ki67 in >50% of the cell nuclei (Ki67/50⁺) were 88% and 64% in MDA respectively, significantly higher than common AUCs (38%, 18%, P < 0.01), CA 125 was 18% in MDA, clearly lower than common AUCs (58%, P < 0.01). There was no difference between MDA and common AUCs for CEA, PR, Vimentin, ER, PCNA and SMA (P > 0.05). No significant difference was noticed among the high, moderate and low differentiation groups in common AUCs (P > 0.05).

Conclusions

For early stage diagnoses, MDA should be considered when cervical hypertrophy is present in patients complaining of a vaginal profuse watery or mucoid discharge and irregular bleeding. Positive immunohistochemical staining for p53, Ki67/50⁺ and negative for CA125 can assist diagnosis and discrimination.     

Minimal deviation endometrioid adenocarcinoma of cervix: a clinicopathological and immunohistochemical study of two cases

We describe the clinicopathological features of two cases of minimal deviation endometrioid adenocarcinoma of cervix. This is a rare tumour whose predominant pattern is one of bland endometrial-type glands infiltrating the cervical wall without a stromal response. Thus, it may be confused with benign conditions such as cervical endometriosis. The two cases demonstrate that this tumour may behave aggressively despite its bland appearances. An immunohistochemical study was performed and showed only focal reactivity of neoplastic glands for carcinoembryonic antigen, which would limit its diagnostic use in small biopsy specimens.     

Diagnosis of autoimmune pancreatitis by core needle biopsy: application of six microscopic criteria

Autoimmune pancreatitis (AIP) has been established as a special entity of chronic pancreatitis (CP). However, its clinical distinction from pancreatic cancer and other types of CP is still difficult. The aim of this study was to evaluate the efficacy of pancreatic core needle biopsy for the diagnosis of AIP. In 44 core needle biopsy specimens, we assessed the following microscopic features: granulocytic epithelial lesions (GELs), more than ten IgG4-positive plasma cells/HPF, more than ten eosinophilic granulocytes/HPF, cellular fibrosis with inflammation, lymphoplasmacytic infiltration, and venulitis. All biopsies that showed four or more of the six features (22 of 44) were obtained from 21 of 26 patients whose clinical diagnosis and follow-up were consistent with AIP. All non-AIP CP patients (n = 14) showed three or less than three of the features in their biopsies. GELs were only observed in biopsy specimens from AIP patients. In conclusion, our data indicate that the six criteria we applied were able to recognize AIP in 76% of biopsy specimens using a cut-off level of four. When the specimens that revealed only three features but showed GELs were added, the sensitivity rose to 86%. Pancreatic core needle biopsy can therefore make a significant contribution to the diagnosis of AIP.     

宫颈毛玻璃细胞癌五例临床病理分析

目的 探讨宫颈毛玻璃细胞癌的临床病理特征、免疫组织化学特点、诊断和预后.方法 回顾性分析了5例宫颈毛玻璃细胞癌的临床特征、脱落细胞学和组织病理学诊断要点及免疫组织化学特点.对照组为非特殊类型宫颈腺鳞癌10例、腺癌10例、鳞状细胞癌20例(角化型和非角化型各10例),非肿瘤性宫颈5例.结果 5例宫颈毛玻璃细胞癌患者平均年...