宫颈原位腺癌合并微小偏离型腺癌临床病理特征分析

摘要

目的 探讨宫颈原位腺癌合并微小偏离型腺癌的临床病理学特征、免疫表型、诊断和鉴别诊断,提高宫颈微小偏离型腺癌的病理学认识.方法 对1例宫颈原位腺癌合并微小偏离型腺癌患者的临床及病理资料进行分析.结果 患者年龄47岁,无阴道不规则流血,月经量及经期无明显改变.宫颈部分腺体呈高级别上皮内瘤变合并原位腺癌和微小偏离型腺癌改变.肿瘤主要由呈浸润性生长的分化较好的粘液性腺体组成.腺体分布大多密集、紊乱,呈多种形状.瘤细胞可有轻度不典型增生.免疫组化结果:微小偏离型腺癌CEA(灶性+)、P53(-)、Ki67 index5％、P16(-)、Calponin(平滑肌+)SMA(平滑肌+)、ER(+)、PR(-)、CA125(-).结论 宫颈微小偏离型腺癌是一种少见的高分化粘液腺癌,分化程度高,容易漏诊.在病理学诊断时要综合考虑患者的临床表现、症状和体征,免疫组化具有一定的辅助诊断价值.%Objective To investigate the clinicpathologic features of adenocarcinoms in situ of the cervical and mini mal deviation adenocarcinoma.Methods 1 case of adenocarcinoms in situ of the cervical and minimal deviation adenocarcinoma was collected and analyzed with review of related literature.Immunohistochemical staining was performed to detect CEA,P53,Ki67,P16,Calponin using the SP method.Results The main symptoms included the watery discharge of cervix,with or without the biopsy difficulty with diagnose after the technique.The part of the gland was high-grade intraepithelial neoplasia and adenocarcinoma in situ and minimal deviation adenocarcinoma.Tumors are mainly composed of mucinous glands that are well-differentiated by invasive growth.Gland distribution was mostly dense,disorder and shape variable.Tumor cells had mild atypical hyperplasia.Immunohistochemical results included CEA (focal +),P53 (-),Ki67 index 5％,P16 (-),Calponin (smooth muscle +),SMA(smooth muscle +),ER(+),PR(-) and CA125 (-).Conclusion Minimal deviation adenocarcinoma is a rare well differentiated mucinous adenocarcinoma,high degree of differentiation and easy to misdiagnosis.The clinical manifestations,symptoms and signs,immunohistochemistry has a certain diagnostic value for diagnose of adenocarcinoms in situ of the cervical and minimal deviation adenocarcinoma.