子宫颈高级别鳞状上皮内病变的病理形态学分析

摘要

Objective:To study cell and pathological characteristics of high-grade squamous intraepithelial lesion.Methods:59 cases of liquid based cytology smear with high-grade squamous intraepithelial lesion and pathological biopsy were studied by optical microscope.Then the cytological and pathological results were analyzed.Results:In the optical microscope,cell morphology with high-grade squamous intraepithelial lesion had three kinds of forms:classical cell morphology;small basal-like cell;cell with fine,uniform distribution,pale-staining chromatin.Biopsy reveal:CIN2 appeared lesions extending the scope of squamous epithelial 2/3;CIN3,1/3 only in the epithelial layer was retained within the layers of dedifferentiation of mature squamous epithelium,or even the whole layer of epithelial cells were completely replaced by lesions.The coincident rate of the diagnosis of TCT cytology and histology was 98%.Conclusion:The test of cervical cytology applying in screening cervical cancer plays a very important role in early detection,diagnosis and treatment of cervical cancer.%　　目的：总结并分析液基细胞学诊断宫颈鳞状上皮内高度病变的细胞病理学特征,探讨如何进一步提高细胞学诊断准确率的问题.方法：通过光镜观察59例符合上皮内高度病变的宫颈液基细胞学涂片,同时收集此59例患者的病理活检切片,进行光镜下组织学诊断,并对比分析细胞学与组织病理学诊断的结果.结果：光镜下上皮内高度病变的细胞形态大致有3种：经典的细胞形态；很小的基底型细胞,细胞小,但染色深,大小不一,核膜不整,核浆比高；染色质匀细、分布均匀、淡染的细胞形态.阴道镜活检镜下示：宫颈上皮内瘤变2级(CIN2)病变范围扩展到鳞状上皮下2/3；CIN3,仅在上皮上1/3层内保留几层分化成熟的鳞状上皮,甚至全层上皮完全被病变细胞所替代.细胞学结果与阴道镜活检符合率达96.9%.结论：宫颈细胞学检查在宫颈癌的早期发现、早期诊断及早期治疗中起着非常重要的作用.