粗针活检诊断子宫颈微偏腺癌4例及临床病理分析

摘要

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.%Purpose To describe the clinicopathologic , immunohistochemical and histochemical characteristics and differential diagnosis of cervical minimal deviation adenocarcinoma ( MDA ) examined by ultrasound-guided core needle biopsy, in order to investigate the advantages and feasihility of the methodology used in early diagnosis of cervical minimal deviation adenocarcinoma. Methods Four cases of ultrasound-guided core needle hiopsy of MDA were analyzed using HE , immunohistochemical and histochemical stains , also,compared with their radical resection specimens, respectively. Results The histopathologic characteristics MDA by of core needle biopsy was well-differentiated, adenocarcinoma with irregular glands and moderate atypia of epithelial cells in the fibrous stroma. and the interstitial fibrous tissue was proliferative change. Also, the irregular glands could be seen around large vessels. The atypia of epithelial cells were positive for CEA by immunohistochemical staining, and positive for AB/PAS by histochemical staining. The diagnosis of MDA was further confirmed by the radical resection specimens. Conclusions MDA sited in deep position ( ＞5 mm ) hy the ultrasound-guided core needle biopsy could satisfy the needs of pathologic diagnosis, and therefore this methodology used in early diagnosis of MDA has its advantages and feasibility.