子宫颈微腺体增生9例临床病理分析

目的探讨宫颈微腺体增生(microglandular hyperplasia,MGH)的临床病理特征及其鉴别诊断。方法观察9例MGH的临床病理特点,并进行组化和免疫组化分析。结果患者年龄为21～46岁的生育期妇女,平均年龄30岁,其中1例为足月妊娠,2例有口服避孕药史;患者通常无症状,于妇科普查时偶然发现宫颈息肉状赘生物,最大直径不超过1.5cm;组织学特点为复杂性增生的小腺体和微囊腔呈小区状分布,小区腺体周围有储备细胞增生或/和不成熟的鳞状上皮化生细胞;腺体或微囊腔内分泌物及部分胞浆内空泡PAS、淀粉酶消化PAS及Alcian Blue(AB)组织化学染色均为阳性,提示其为黏液性分泌物;免疫组化CEA、p53、Ki-67、Vimentin均为阴性,可与相应的恶性病变鉴别。结论 MGH是发生于宫颈的良性病变,是宫颈储备细胞在孕激素的作用下活跃增生并向腺上皮分化的形态学表现,有必要充分熟悉此特殊类型病变,避免误诊或漏诊;组化和免疫组化在鉴别诊断中具有重要意义。

Clinicopathologic analysis of 9 cases of microglandular hyperplasia in cervix

Objective To study the clinicopathologic features and differential diagnosis of microglandular hyperplasia （MGH） in cervix.Methods Clinicopathologic features of 9 MGH cases in cervix were studied and the histochemical and immunohistochemical analysis performed.Results The patients were women of childbearing ages from 21 to 46 years （30 years on average）.Of the 9 cases,one was full-term pregnancy and two had history of oral contraceptives.The patients were usually asymptomatic and accidentally found to have a cervical polypoid ecphyma measuring less than 1.5cm.Histologic characteristics showed small glands of complex hyperplasia and district distribution of microcapsules cavity.Reserve cell hyperplasia and/or immature squamous metaplasia cells appeared around glandular organs.PAS of secretion came from glandular organ or microcapsule and some intracytoplasmic vacuoles,amylase digestion PAS and Alcian Blue （AB） stained by histochemistry were all positive,which suggested the secretion was mucous.CEA,p53,Ki-67 and Vimentin were negative by immunohistochemical staining,which could be distinguished with corresponding malignant change.Conclusion MGH is a kind of benign lesion occurred in cervix and morphological features of cervical reserve cells under the action of progesterone which actively proliferate and differentiate to glandular epithelium.It is necessary to fully master this particular type of disease to avoid misdiagnosis or missed diagnosis.Histochemistry and immunohistochemistry are important in the differential diagnosis of MGH.