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。     

子宫颈高分化胃型黏液腺癌1例

<正>患者女性,28岁。因经期延长约15天,经量增多就诊于我院。自诉无接触性阴道出血,2年前HPV68、81及HPV E6/E7检测均阳性,阴道镜检查见白色上皮及点状血管,血管粗大,碘不着色。实验室检查：CA199 88.3 U/mL、CA125 20.10 U/mL、SCC 0.70 ng/mL、CEA 1.21 ng/mL,阴道超声：子宫大小6.6 cm×5.2 cm×5.0 cm, 子宫颈后唇见一大小2.4 cm×9.0 cm无回声区,     

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。     

粗针活检诊断子宫颈微偏腺癌4例及临床病理分析

目的 总结B超引导下子宫颈微偏腺癌(minimal deviation adenocarcinoma,MDA)的粗针穿刺活检组织病理学形态、免疫组化及组织化学染色、病理诊断和鉴别诊断等要点,结合文献分析粗针穿刺活检方法用于临床早期诊断子宫颈MDA的优势及可行性.方法 对4例临床疑为MDA的患者,在B超引导下进行深部粗针穿刺活检,经常规HE染色、免疫组化及特殊染色后,镜下观察做出病理诊断,与该患者根治切除标本进行对比分析.结果 镜下见子宫颈深部穿刺标本的纤维和平滑肌组织中,散在分化较好的子宫颈型黏液性腺体,但腺体形态不规则,细胞轻至中度异型以及周围纤维组织增生性的间质反应,并且可见腺体邻近大血管;免疫组化染色腺上皮CEA阳性,AB/PAS特殊染色阳性.根治切除标本进一步明确了MDA的诊断,证实术前的子宫颈深部组织粗针穿刺活检获得的组织学证据,足以支持MDA的病理诊断.结论 MDA病变位置较深,间质浸润是明确诊断的最主要依据,粗针穿刺可做到子宫颈深部(深度>5 mm)活检,作为MDA早期诊断的一种方法具有一定的优势和可行性.     

子宫颈浸润性复层产黏液的癌6例临床病理分析

目的 探讨子宫颈浸润性复层产黏液的癌(invasive stratified mucin-producing carcinoma, ISMC)的临床病理学特征及预后。方法 回顾性分析2019～2021年褔建省肿瘤医院诊治的6例子宫颈ISMC的临床病理学及免疫表型特征,并复习相关文献。结果 6例均可见经典的ISMC形态,实性癌巢由胞质内黏液多少不等的复层上皮细胞组成,边界较圆钝,巢周细胞呈栅栏状排列,类似子宫颈产黏液的复层上皮内病变。转移灶与原发灶形态一致或癌巢较不规则。免疫表型：肿瘤细胞p16、CEA、CK7、CK8/18均阳性,ER、PR、PAX8和Syn均阴性,CK5/6、p40阴性或灶性阳性,Ki-67增殖指数为70%～80%。结论 子宫颈ISMC是新近命名的HPV相关的腺癌亚型,具有独特的形态学及免疫表型特征,预后较其它HPV相关腺癌差,识别子宫颈癌中ISMC成分具有临床意义。     

子宫颈胃型黏液性癌18例临床病理分析

目的 探讨子宫颈胃型黏液性癌的临床病理学特征、诊断及鉴别诊断、治疗及预后.方法 回顾性分析18例子宫颈胃型黏液性癌的临床病理学、影像学、实验室检查及免疫表型特征等,并复习相关文献.结果 患者年龄24～64岁,平均48岁.临床表现:7例为阴道淋漓出血或接触性出血,7例为下腹痛,4例为阴道分泌物增多.眼观:13例子宫颈或子...     

p16及HPV分型检测在子宫颈黏液腺癌伴双侧卵巢转移中的诊断价值

目的 探讨联合使用免疫组化标记p16及HPV分型检测在诊断和鉴别诊断子宫颈黏液腺癌伴双侧卵巢转移中的诊断价值.方法 分析3例子宫颈黏液腺癌伴双侧卵巢转移的临床病理学特征,对子宫颈及卵巢的癌灶进行含p16在内的多个免疫组化标志物染色及HPV分型检测.结果 3例患者的子宫颈均有不同程度的肥大、糜烂及肿块,双侧卵巢增大,切面有黏液感伴出血、坏死;镜下可见子宫颈腺癌周围有不典型增生的子宫颈管腺上皮,与腺癌移行过渡,可见癌栓,腺癌几乎侵及子宫颈全层;双侧卵巢纤维增生明显,腺癌穿插其中.颈体交界、子宫内膜、输卵管黏膜、阴道手术切缘等查见癌累及.3例子宫颈及卵巢癌灶的免疫表型基本一致,均强阳性表达p16、CK7和Ki-67,HPV亚型分型检测阳性结果如下.子宫颈/卵巢:例1,16、18/16、18、58;例2,16、18/18;例3,16/18.根据p16的表达及HPV分型检测结果,提示3例均为子宫颈黏液腺癌伴双侧卵巢转移.结论 子宫颈黏液腺癌伴双侧卵巢转移属于晚期子宫颈癌.借助p16的表达及HPV亚型的分型检测结果可诊断及鉴别诊断肿瘤的原发部位,有利于肿瘤的后期治疗.     

原发性宫颈腺癌的临床病理及免疫组织化学分析

目的 探讨宫颈腺癌的病理分类,免疫组化表达特征,鉴别诊断及预后的因素。方法 对９８例原发性宫颈腺癌进行临床病理及免疫组化分析,并与１８例子宫内膜腺癌的免疫组化进行比较。其中５４例进行了跟踪随访。结果 将本组原发性宫颈腺癌分为５类,其中以宫颈内膜型（ｅｎｄｏｃｅｒｖｉｃａｌ）最为常见。免疫组化;癌胚抗原（ＣＥＡ）,人乳头瘤病毒１６及６Ｂ／１１型（ＨＰＶ１６及ＨＰＶ６Ｂ／１１）染色的阳性率分别为８３．     

宫颈恶性腺瘤6例临床病理分析

目的 探讨宫颈恶性腺瘤(cervical adenoma malignum，CAM)临床病理学特征及早期诊断。方法 对6例CAM的临床资料及3例阳性涂片进行分析，选用CEA、c—erbB—2、CD44v6、Ezrin(p81)和mucin5种抗体采用二步法进行免疫组化染色。结果 CAM临床表现均有白带大量增多，但白带检验结果无异常。3例细胞学涂片显示特征性图像。CEA在6例CAM中有阳性表达，而在正常宫颈组织中仅1例表达。其余4项免疫组化指标对CAM和正常宫颈组织的表达尢差异。结论 细胞学检查在CAM早期诊断中有重要意义。CEA阳性对CAM与良性宫颈病变有一定鉴别意义。临床白带长时间大量增多且化验无异常发现时应警惕CAM的可能。     

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.     

Cervical adenocarcinoma with stromal micropapillary pattern

Adenocarcinoma with a stromal micropapillary pattern (SMP) has been described in various organs, but not in the uterus. We encountered a case of uterine cervical carcinoma with SMP. A54‐year‐old Japanese woman was referred to the hospital with abnormal vaginal bleeding. The cervical cytodiagnosis was adenocarcinoma with features resembling serous adenocarcinoma. Cervical cytology showed many small clusters of tumor cells, present in up to two or three layers, composed of atypical cells with markedly increased nucleus: cytoplasm ratios. A radical hysterectomy with bilateral adnexectomy and retroperitoneal lymph node dissection was performed. Microscopically, the tumor was composed predominantly of adenocarcinoma with SMP. The outer surface of the SMP cell clusters showed membranous expression of mucin‐1 (MUC‐1). Many lymph node metastases were detected. The tumor was diagnosed as a cervical adenocarcinoma with SMP and coexistent squamous cell carcinoma in situ. The pathology was classified as T1b1N1M1, stage IVB. The patient underwent postoperative adjuvant chemotherapy and is without local recurrence or distant metastasis 48 months after the operation. To the best of our knowledge, this is the first reported case of cervical adenocarcinoma with SMP. Diagn. Cytopathol. 2016;44:133–136. © 2015 Wiley Periodicals, Inc.     

偶发性前列腺癌5例临床病理分析

目的探讨偶发性前列腺腺癌的发生率、临床及病理特点。方法收集40例复旦大学附属肿瘤医院因膀胱癌而行膀胱前列腺根治切除标本中偶然发现的前列腺腺癌5例,观察并分析其临床表现、病理学特点。结果临床表现:40例膀胱前列腺根治切除标本中有5例合并前列腺腺癌,发生率为12.5%(5/40)。患者平均年龄66岁(63～70岁)。4例表现为肉眼血尿,1例为镜下血尿。术前血PSA水平仅1例为6.55 ng/ml(参考值4.0 ng/ml),另外4例PSA水平均<4.0 ng/ml。病理检查:5例均为腺泡源性腺癌,4例Gleason分级评分均为6(3+3),1例Gleason分级评分为7(4+3)。临床病理TNM分期:3例为T1a,2例为T1b。结论前列腺癌可与尿路上皮癌合并发生,往往血PSA水平正常或稍高于正常。Gleason评分较低,癌灶常较局限,如取材不充分可能会漏诊。     

前列腺基底细胞癌3例临床病理分析

目的 探讨前列腺基底细胞癌(basal cell carcinoma,BCC)的临床病理学特征、免疫表型、病理诊断及鉴别诊断.方法 采用HE及免疫组化法对3例前列腺BCC进行观察,并复习相关文献.结果 患者发病年龄分别为39、69及75岁.镜下见瘤细胞较小,异型性较轻,瘤细胞呈巢状、小梁状或筛状排列,巢及小梁边缘的瘤细胞可呈栅栏状排列.肿瘤呈浸润性生长.免疫表型:瘤细胞表达CK(34βE12)、p63及CK5,不表达PSA和P504s.结论 诊断前列腺BCC需结合临床资料、HE形态和免疫表型,其生物学行为可表现出较强的侵袭性.     

Wolffian附件肿瘤的临床病理观察

目的 观察Wolffian附件肿瘤的临床病理特点,探讨其病理诊断与鉴别诊断。方法 对3例Wolffian附件肿瘤进行HE及免疫组化染色（EnVision法）,并进行病理观察。结果 3例Wolffian附件肿瘤均为单侧,位于阔韧带或输卵管系膜。镜下肿瘤细胞呈弥漫实体状分布,可见成片的梭形或多边形细胞及排列紧密的管状结构。管腔内衬立方或柱状上皮,细胞无明显异型,核分裂象少见。管周有PAS阳性的基膜物质。免疫组化示肿瘤细胞vimentin、AE1／AE3、α-inhibin、calretinin和WT1均呈阳性,CD99呈灶性阳性,EMA和CK7呈阴性。结论 Wolffian附件肿瘤是具有独特发病部位和组织病理学特点的妇科肿瘤,需要和一系列其他妇科肿瘤鉴别。     

Cervical adenocarcinoma: integration of HPV status,pattern of invasion,morphology and molecular markers into classification

Cervical adenocarcinoma is a heterogenous group of tumours with various aetiologies, molecular drivers, morphologies, response to treatment and prognosis. It has become evident that human papillomavirus (HPV) infection does not drive all adenocarcinomas, and appropriate classification is critical for patient management, especially in the era of the HPV vaccine and HPV-only screening. Identified as one of the most important developments in gynaecological pathology during the past 50 years, the separation of cervical adenocarcinomas into HPV-associated (HPVA) and HPV-independent has resulted in a transformation of the classification system for cervical adenocarcinomas. HPVA has been traditionally subclassified by morphology, such as usual type (UEA), mucinous and villoglandular, etc. However, it has become evident that cell type-based histomorphological classification is not clinically meaningful, and the newly proposed International Endocervical Adenocarcinoma Criteria and Classification (IECC) is a necessary and relevant break from this prior system. Non-HPV-associated adenocarcinomas can be divided by their distinct morphology and molecular genomics with very different responses to standard therapies and potential for future targeted therapies. These include gastric-type, clear-cell, mesonephric and endometrioid adenocarcinomas. So-called ‘serous’ carcinomas of the cervix probably represent morphological variants of UEA or drop metastases from uterine or adnexal serous carcinomas, and the existence of true cervical serous carcinomas is in question. This review will discuss the advances since WHO 2014, and how HPV status, pattern of invasion as described by Silva and colleagues, histological features and molecular markers can be used to refine diagnosis and prognostication for patients with cervical adenocarcinoma.