宫颈微偏腺癌8例病理形态学分析(1)
【摘要】 目的探讨宫颈微偏腺癌的临床和病理学特征。方法对我院2000年至2009年经病理证实的8例宫颈微偏腺癌患者临床病理资料进行回顾性分析。就其临床病理形态学、免疫表型特征进行观察分析,并探讨其诊断和鉴别诊断。结果MDAC的临床主要表现为阴道不规则流血及大量稀黏液性白带,宫颈肥大和糜烂。病理特征为腺体轻度增生,大小不一、形态不规则、有轻度异型性,腺体侵入宫颈壁并有特殊间质反应。AB(pH2.5)/PAS染色证实,腺体腔内为混合性黏液,主要含唾液酸黏液,硫酸黏液减少,中性黏液较多。免疫表型:MDAC腺体上皮阳性表达CEA;CK7、CK19、CA-199表达均为阳性;vimentin、SMA浸润性腺体周围纤维母细胞/肌纤维母细胞均为阳性。结论宫颈微偏腺癌早期诊断率非常低,临床上应警惕宫颈水样溢及宫颈肥大者,应争取多取材并尽量争取宫颈深活检,AB(pH2.5)/PAS特殊染色与CEA;CK7、CK19、CA-199免疫组化指标,对于宫颈微偏腺癌具有辅助诊断价值。
【关键词】 宫颈微偏腺癌病理学诊断
, http://www.100md.com
【中图分类号】 R737.33【文献标识码】 A【文章编号】 1674-0742(2011)07(b)-0005-02
【Abstract】 Objective To explore the cervical adenocarcinoma of the small slant clinical and pathological features.Methods A total from 2000 to 2009 8 cases of pathologically proven cervical small slant adenocarcinoma patients clinical data were retrospectively analyzed. The clinical and pathological morphology,immunophenotype characteristics were observed and analyzed,and discuss the diagnosis and differential diagnosis.results MDAC clinical mainly for vaginal irregular bleeding and massive dilute mucous sex leucorrhea,cervix hypertrophy and erosion.Histology of the gland mild hyperplasia,size is differ,shape irregular,have minimal atypia,glands and have special intrusive cervical wall interstitial response.AB (pH2.5)/a PAS stain confirmed that glands cavity mucous,mainly for mixed with saliva acid mucus,sulfuric acid mucous decrease,neutral mucous more.Immunophenotype:MDAC glands epithelial positive express CEA;CK7 and CK19,CA-199 expression are all positive;Vimentin,SMA infiltrating glands body surrounding fibroblast/myofibroblasts cells are all positive.Conclusion the cervix small slant adenocarcinoma early diagnosis rate is very low,clinical samples should be vigilant cervical overflow and cervical hypertrophy,who should strive for many materials and try to fight for cervical deep biopsy,AB (pH 2.5)/PAS special dyeing and CEA;CK7 and CK19,CA-199 immunohistochemical index,for cervical adenocarcinoma of the small slant with auxiliary diagnostic value.
, 百拇医药
【Key Words】 Cervical Small Slant Adenocarcinoma;Pathology;Diagnosis
宫颈微偏腺癌(Minimal deviation adenocarcinoma,MDAC)是一种高度分化的恶性腺上皮肿瘤。占宫颈腺癌发病率的1%～3%,近年来其发病率呈上升趋势,尤其在年轻妇女中常见。由于MDAC早期缺乏临床和病理学特征,患者往往因多次活检难以定性而延误手术时间,少数患者直到广泛转移才得以确诊。目前,MDAC已引起越来越多临床和病理工作者重视。本文收集我院8例MDAC患者资料,对其临床、病理形态学、组织化学和免疫表型特征进行回顾性分析。
1资料与方法
1.1一般资料
收集2000年9月至2009年9月来我院就诊的8例MDAC患者病例资料,另选8例宫颈糜烂,腺体增生患者作为对照组。患者年龄26～68岁,平均47.2岁。病程:<1年5例,1～2年2例,>2年1例。症状主要为水样白带(有臭或无)7例,伴阴道不规则流血6例、下腹胀痛3例、接触出血2例,停经1例。妇科检查:宫颈肥大及质硬6例,重度糜烂5例,表面凹凸不平4例,接触性出血和质脆各2例,韧带或盆底增厚6例,卵巢囊肿3例。8例均经阴道镜下取活检病理诊断为MDAC。
, 百拇医药
1.2方法
8例MDAC患者均行全子宫切除及附件切除,发生盆腔淋巴结转移的进行淋巴清扫术。标本均经10%福尔马林固定,常规脱水,石蜡包埋,切片厚4μm,HE染色,光镜观察,同时做AB(pH2.5)/PAS组织化学染色和CEA、CA-199、CK7、CK19、vimentin、SMA等免疫组化染色,免疫组化染色采用微波修复抗原、即用型试剂Envision二步法进行。所用试剂和工作液全部购自北京中杉金桥生物技术有限公司。
2结果
2.1临床检查
发现8例宫颈阴道不规则流血及大量稀黏液性白带,表面呈不同程度的糜烂,乳头状或息肉状增生,后期宫颈异常肥大,呈桶状或拳头状,质硬,颈管狭窄,活动欠佳。其中子宫颈明显肥大4例,较正常大2～3倍,最厚处达3cm,并且外翻呈桶状。表面轻至中度糜烂3例,子宫颈口息肉样和菜花状新生物2例,其中3例可见肿瘤浸润到宫颈外纤维膜下,3例向外浸润到阴道,1例向内浸润到子宫内膜,1例向输卵管转移。
2.2显微镜检查, 百拇医药(陈国群)
【关键词】 宫颈微偏腺癌病理学诊断
, http://www.100md.com
【中图分类号】 R737.33【文献标识码】 A【文章编号】 1674-0742(2011)07(b)-0005-02
【Abstract】 Objective To explore the cervical adenocarcinoma of the small slant clinical and pathological features.Methods A total from 2000 to 2009 8 cases of pathologically proven cervical small slant adenocarcinoma patients clinical data were retrospectively analyzed. The clinical and pathological morphology,immunophenotype characteristics were observed and analyzed,and discuss the diagnosis and differential diagnosis.results MDAC clinical mainly for vaginal irregular bleeding and massive dilute mucous sex leucorrhea,cervix hypertrophy and erosion.Histology of the gland mild hyperplasia,size is differ,shape irregular,have minimal atypia,glands and have special intrusive cervical wall interstitial response.AB (pH2.5)/a PAS stain confirmed that glands cavity mucous,mainly for mixed with saliva acid mucus,sulfuric acid mucous decrease,neutral mucous more.Immunophenotype:MDAC glands epithelial positive express CEA;CK7 and CK19,CA-199 expression are all positive;Vimentin,SMA infiltrating glands body surrounding fibroblast/myofibroblasts cells are all positive.Conclusion the cervix small slant adenocarcinoma early diagnosis rate is very low,clinical samples should be vigilant cervical overflow and cervical hypertrophy,who should strive for many materials and try to fight for cervical deep biopsy,AB (pH 2.5)/PAS special dyeing and CEA;CK7 and CK19,CA-199 immunohistochemical index,for cervical adenocarcinoma of the small slant with auxiliary diagnostic value.
, 百拇医药
【Key Words】 Cervical Small Slant Adenocarcinoma;Pathology;Diagnosis
宫颈微偏腺癌(Minimal deviation adenocarcinoma,MDAC)是一种高度分化的恶性腺上皮肿瘤。占宫颈腺癌发病率的1%～3%,近年来其发病率呈上升趋势,尤其在年轻妇女中常见。由于MDAC早期缺乏临床和病理学特征,患者往往因多次活检难以定性而延误手术时间,少数患者直到广泛转移才得以确诊。目前,MDAC已引起越来越多临床和病理工作者重视。本文收集我院8例MDAC患者资料,对其临床、病理形态学、组织化学和免疫表型特征进行回顾性分析。
1资料与方法
1.1一般资料
收集2000年9月至2009年9月来我院就诊的8例MDAC患者病例资料,另选8例宫颈糜烂,腺体增生患者作为对照组。患者年龄26～68岁,平均47.2岁。病程:<1年5例,1～2年2例,>2年1例。症状主要为水样白带(有臭或无)7例,伴阴道不规则流血6例、下腹胀痛3例、接触出血2例,停经1例。妇科检查:宫颈肥大及质硬6例,重度糜烂5例,表面凹凸不平4例,接触性出血和质脆各2例,韧带或盆底增厚6例,卵巢囊肿3例。8例均经阴道镜下取活检病理诊断为MDAC。
, 百拇医药
1.2方法
8例MDAC患者均行全子宫切除及附件切除,发生盆腔淋巴结转移的进行淋巴清扫术。标本均经10%福尔马林固定,常规脱水,石蜡包埋,切片厚4μm,HE染色,光镜观察,同时做AB(pH2.5)/PAS组织化学染色和CEA、CA-199、CK7、CK19、vimentin、SMA等免疫组化染色,免疫组化染色采用微波修复抗原、即用型试剂Envision二步法进行。所用试剂和工作液全部购自北京中杉金桥生物技术有限公司。
2结果
2.1临床检查
发现8例宫颈阴道不规则流血及大量稀黏液性白带,表面呈不同程度的糜烂,乳头状或息肉状增生,后期宫颈异常肥大,呈桶状或拳头状,质硬,颈管狭窄,活动欠佳。其中子宫颈明显肥大4例,较正常大2～3倍,最厚处达3cm,并且外翻呈桶状。表面轻至中度糜烂3例,子宫颈口息肉样和菜花状新生物2例,其中3例可见肿瘤浸润到宫颈外纤维膜下,3例向外浸润到阴道,1例向内浸润到子宫内膜,1例向输卵管转移。
2.2显微镜检查, 百拇医药(陈国群)