协和医学杂志

2012, (01)

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宫颈绒毛腺管状腺癌的临床病理

郭丽娜;游燕

摘要(Abstract):

目的:分析宫颈绒毛腺管状腺癌的临床病理特征,探讨其诊断标准及预后因素。 方法:对10例宫颈绒毛腺管状腺癌的临床病理表现进行评估,临床方面包括年龄、症状、术前检查、FIGO分期、治疗方式及随访情况,病理方面包括大体表现、颈管浸润程度、有无淋巴结转移及淋巴脉管内瘤栓、组织学分型、核异性型、核分裂及伴随病变。 结果:10例患者的平均发病年龄为39岁。7例FIGO分期Ib1期,1例IIa期,1例Ia1。手术方式为全子宫切除及盆腔淋巴结清扫术及双附件切除术或卵巢活检术。术后平均随访29个月,8例健康生存,1例复发,1例失访。大体观察,5例呈息肉样或菜花状外生性肿物,直径5mm至25mm,4例呈乳头状或细绒毛样粗糙区,面积25x14mm至35x20mm,1例术后转移病例表现为溃疡型肿物,直径25mm。镜下肿瘤浸润深度从2mm至12mm,浸润宽度从5mm至26mm,1例累及阴道后穹窿。9例有轻-中度核异型性,1例术后转移病例呈中-重度核异型性。核分裂平均48个/10HPF。9例伴CIN III和/或ACIS,其中2例同时伴有高分化粘液腺癌。1例观察到宫颈壁内个别淋巴脉管内瘤栓。所有10例均未发现子宫体受累、盆腔淋巴结或卵巢转移。 结论:宫颈绒毛腺管状腺癌的整体预后较好。提示不良预后的病理指标除了宫颈管壁深层的浸润、累及宫体、血管浸润、淋巴结转移之外,还需包括肿瘤细胞重度异型性和/或存在其它类型恶性程度更高的肿瘤成分。
Objectives. The objectives of this study are to analyze the clinicopathologic features of villoglandular papillary adenocarcinoma (VGPA) of the uterine cervix and to discuss the diagnostic standards and prognostic factors. Methods. 10 patients with VGPA were examined. Clinical profiles, including patient age, clinical stage, surgical procedure, and outcome, were recorded. Pathologically, macroscopic features, tumor size, horizontal spread and depth of endophytic tumor, nuclear atypicality, mitotic count, lymph capillary space invasion, and lymph node metastasis were investigated. Results. The median age of 10 patients was 39 years, with 8 patients staged FIGO Ib1, 1 patient staged IIa and 1 patient staged Ia. All the patients underwent hysterectomy and lymphadenectomy and are alive, but 1 patient recurrent. Macroscopically, 5 cases showed exophytic polypoid or florid lesions with the diameter ranged between 5-25mm, 3 cases showed microvillous rough regions with area ranged between 25x14-35x20mm, and the other recurrent case showed an ulcerative type of mass with the diameter of 25mm. Horizontal spread and depth of endophytic tumor ranged between 5 and 26 mm and between 2 and 16 mm, respectively; the invasion of posterior fornix of vagina was observed in one case. All the cases showed mild to moderate cytologic atypia, except the recurrent one showed severe cytologic atypia. The mean mitotic count was 48/10 high-power fields. CIN III or ACIS or a mixture of the two was discovered in 9 cases, 2 of whom were simultaneously in association with well-differentiated adenocarcinoma. Occasional lymph capillary space invasion was present in one case. None had corpus infiltration, bulky lymph node metastases or ovary metastasis. Conclusions. VGPA usually has a favorable prognosis. Besides tumor infiltration of outer one-third cervical wall, corpus infiltration, vascular invasion, positive lymph nodes, the poor prognostic factors should include severe cytologic atypia and/or any other more aggressive malignant tumor.

关键词(KeyWords): |绒毛腺管状腺癌、宫颈、淋巴脉管内瘤栓、核分裂数、诊断标准、预后因素|
|Villoglandular adenocarcinoma| Uterine cervix| Lymph capillary space invasion| Mitotic count| Diagnostic standards| Prognostic factors|

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作者(Author): 郭丽娜;游燕

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