宫颈微偏腺癌临床与病理分析

目的：探讨宫颈微偏腺癌（MDA）的临床、病理学特征、治疗及预后。方法：回顾性分析我院于1986年1月至2012年12月收治的13例MDA患者的临床病理资料并结合文献讨论。结果：本组病例占同期宫颈腺癌治疗患者的2.64％。最常见的临床症状为阴道排大量稀薄黏液及不规则阴道流血。妇科检查通常发现宫颈肥大，典型者呈桶状。病理特征为肿瘤组织学分化良好，腺体浸润深达宫颈间质深层，易侵犯脉管且伴有特殊的间质反应。确诊时Ⅱa期及以后患者占69.23％，30.76％的患者手术时已发生盆腔淋巴结转移。13例患者全部行广泛性全子宫切除术，Ⅱa期及以后患者行放化疗。9例有随访资料的患者5例死亡，4例健在。结论：MDA早期诊断困难，预后不良。MDA诊断主要依据临床症状及腺体浸润较深、易侵犯脉管伴特殊间质反应等病理学特征。早期患者应尽量采用根治性手术，对晚期患者实施放化疗效果差。及时确诊是治疗的关键。

Clinicopathological study of minimal deviation adenocarcinoma of the cervix

Objective：To evaluate the clinicopathologicul features,treatment and prognosis of minimal deviation adenocarcinoma （MDA）. Methods：The medicul records and clinicopathologicul results of 13 patients with MDA were retrospectively reviewed. Results：The study group comprised 2.64% of all the in - patients with cervical adenocarcinoma managed in the same period. The most common compliant was a large amount of watery and irregular vaginal bleeding. Histologically,tumor cells were well differentiated. Glands deeply invaded into cervical stroma, and commonly with vascular space invasion and specific periglandular stromul reaction. The stage Ⅱ. and after Ⅱ. comprised 69.23% of all the patients when diagnosed. Conclusion： MDA is difficult to diagnose early by conventional biopsy and has poorly prognosis. Diagnosis of MDA mainly depends on the clinical symptoms and pathological features which include deep gland invasion,vascular space invasion and specific pariglandular stromal reaction. Radical surgery and adjuvent chemoradiation might be the proper choice. The critical measure for MDA treatment is making a definite diagnosis in time.