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宫颈绒毛腺管状腺癌的临床病理

游燕,  郭丽娜

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文章导航 > 协和医学杂志  > 2012 >  3(1): 61-67
游燕, 郭丽娜. 宫颈绒毛腺管状腺癌的临床病理[J]. 协和医学杂志, 2012, 3(1): 61-67. doi: 10.3969/j.issn.1674-9081.2012.01.014
引用本文: 游燕, 郭丽娜. 宫颈绒毛腺管状腺癌的临床病理[J]. 协和医学杂志, 2012, 3(1): 61-67. doi: 10.3969/j.issn.1674-9081.2012.01.014
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Yan YOU, Li-na GUO. Clinicopathologic Features of Villoglandular Papillary Adenocarcinoma of the Uterine Cervix[J]. Medical Journal of Peking Union Medical College Hospital, 2012, 3(1): 61-67. doi: 10.3969/j.issn.1674-9081.2012.01.014
Citation: Yan YOU, Li-na GUO. Clinicopathologic Features of Villoglandular Papillary Adenocarcinoma of the Uterine Cervix[J]. Medical Journal of Peking Union Medical College Hospital, 2012, 3(1): 61-67. doi: 10.3969/j.issn.1674-9081.2012.01.014
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宫颈绒毛腺管状腺癌的临床病理

doi: 10.3969/j.issn.1674-9081.2012.01.014

  • 中国医学科学院 北京协和医学院 北京协和医院病理科, 北京 100730

详细信息
    通讯作者:

    郭丽娜 电话:010-65295521, E-mail:luna0076@sina.com

  • 中图分类号: R73;R446.8

Clinicopathologic Features of Villoglandular Papillary Adenocarcinoma of the Uterine Cervix

  • Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

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    摘要
  • 摘要:   目的  探讨宫颈绒毛腺管状腺癌的临床病理特征、诊断标准及预后。  方法  分析北京协和医院10例宫颈绒毛腺管状腺癌的临床病理表现, 临床资料包括年龄、症状、术前检查、国际妇产科联盟(International Federation of Gynecology Obstetrics, FIGO)分期、治疗方式及随访结果, 病理表现包括大体表现、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、核异型性、核分裂及伴随病变。  结果  10例患者平均发病年龄为39岁; 8例FIGO分期Ib1, 1例IIa, 1例Ia1;手术方式为全子宫切除+盆腔淋巴结清扫术+双附件切除术/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5~25 mm; 4例呈乳头状或细绒毛样粗糙区, 面积25 mm×14 mm至35 mm×20 mm; 1例术后转移病例表现为溃疡型肿物, 直径25 mm。镜下肿瘤浸润深度2~12 mm, 浸润宽度5~26 mm, 1例累及阴道后穹窿; 9例有轻-中度核异型性, 术后转移1例病例呈中-重度核异型性; 核分裂平均48个/10高倍视野(HPF); 9例伴有宫颈上皮内瘤变Ⅲ级(cervical intraepithelial neoplasia Ⅲ, CIN Ⅲ)和/或原位腺癌(adenocarcinoma in situ, ACIS), 2例同时伴有高分化黏液腺癌; 1例观察到宫颈壁内个别淋巴脉管内瘤栓。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预后整体较好。提示预后不良的病理指标除了宫颈管壁深层浸润、累及宫体、血管浸润、淋巴结转移外, 还包括肿瘤细胞重度异型性和/或合并其他恶性程度更高的肿瘤成分。
    Abstract:   Objective  To explore the clinicopathologic features, diagnostic criteria, and prognostic factors of villoglandular papillary adenocarcinoma (VGPA) of the uterine cervix.  Methods  We retrospectively analyzed the clinical and pathological data of 10 VGPA patients including age, clinical stage, surgical procedure, outcome, macroscopic features, tumor size, horizontal spread and depth of endophytic tumor, nuclear atypicality, mitotic count, lymph capillary space invasion, and lymph node metastasis.  Results  The median age was 39 years. Eight patients were at stage FIGO Ib1, one at stage IIa, and one at stage Ia1. All patients who had undergone hysterectomy and lymphadenectomy were alive, one patient experienced recurrence, and one patient was lost to the follow-up. Macroscopically, 5 cases showed exophytic polypoid or florid lesions with the diameter ranged between 5-25 mm, 3 cases showed microvillous rough regions with area ranged between 25 mm×14 mm-35 mm×20 mm, and the recurrent case showed an ulcerative type of mass with the diameter of 25 mm. Horizontal spread and depth of endophytic tumor ranged between 5 -26 mm and between 2 -12 mm, respectively; the invasion of posterior fornix of vagina was observed in one case. All the non-recurrent cases showed mild to moderate cytologic atypia, while the recurrent one showed severe cytologic atypia. The mean mitotic count was 48/10 HPF. Cervical intraepithelial neoplasia (CIN) Ⅲ and/or acute coronary ischemia syndrome (ACIS) or a mixture of the two were found in 9 cases, 2 of which were simultaneously in association with welldifferentiated 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. Predictors of a poor outcome include tumor infiltration of outer one-third cervical wall, corpus infiltration, vascular invasion, and positive lymph nodes; meanwhile, severe cytologic atypia and/or any other more aggressive malignant tumor can also play a role.
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  • 图  1  肿瘤表面富于纤维间质的粗乳头结构(HE, ×40)

    下载: 全尺寸图片 幻灯片

    图  2  肿瘤表面具有纤维血管轴心的细乳头结构, 间质内见炎细胞浸润, 被覆假复层柱状上皮有轻-中度异型性(HE, ×100)

    下载: 全尺寸图片 幻灯片

    图  3  高度异型性的乳头被覆上皮, 核分裂象(箭头)易见(HE, ×200)

    下载: 全尺寸图片 幻灯片

    图  4  宫颈绒毛腺管状腺癌合并宫颈上皮内瘤变Ⅲ级(HE, ×40)

    下载: 全尺寸图片 幻灯片

    图  5  宫颈绒毛腺管状腺癌合并宫颈原位腺癌(HE, ×40)

    下载: 全尺寸图片 幻灯片

    表  1  宫颈绒毛腺管状腺癌的术前诊断

    表  2  宫颈绒毛腺管状腺癌的术前诊断

    表  3  宫颈绒毛腺管状腺癌的病理表现
    • 参考文献(16)
  • [1] Jones MW, Silverberg SG, Kurman RJ. Well-differentiated villoglandular adenocarcinoma of the uterine cervix:a clinicopathological study of 24 cases[J]. Int J Gynecol Pathol, 1993, 12:1-7. doi:  10.1097/00004347-199301000-00001
    [2] Jones MW, Kounelis S, Papadaki H, et al. Well-differentiated villoglandular adenocarcinoma of the uterine cervix:oncogene/tumor suppressor gene alterations and human papillomavirus genotyping[J]. Int J Gynecol Pathol, 2000, 19:110-117. doi:  10.1097/00004347-200004000-00003
    [3] An HJ, Kim KR, Kim IS, et al. Prevalence of human papillomavirus DNA in various histological subtypes of cervical adenocarcinoma:a population-based study[J]. Mod Pathol, 2005, 18:528-534. doi:  10.1038/modpathol.3800316
    [4] Heatley MK. Villoglandular adenocarcinoma of the uterine cervix-a systematic review of the literature[J]. Histopathology, 2007, 51:268-269. doi:  10.1111/j.1365-2559.2007.02759.x
    [5] Alfsen GC, Reed W, Abeler VM. Reproducibility of classification in non-squamous cell carcinomas of the uterine cervix[J]. Gynecol Oncol, 2003, 90:282-289. doi:  10.1016/S0090-8258(03)00280-4
    [6] Young RH, Scully RE. Villoglandular papillary adenocarcinoma of the uterine cervix. a clinicopathologic analysis of 13 cases[J]. Cancer, 1989, 63:1773-1779. doi:  10.1002/1097-0142%2819900501%2963%3A9%3C1773%3A%3AAID-CNCR2820630920%3E3.0.CO%3B2-J
    [7] Utsugi K, Shimizu Y, Akiyama F, et al. Clinicopathologic features of villoglandular papillary adenocarcinoma of the uterine cervix[J]. Gynecol Oncol, 2004, 92:64-70. doi:  10.1016/j.ygyno.2003.10.020
    [8] Rubesa-Mihaljević R, Vrdoljak-Mozetić D, Ostojić DV, et al. Villoglandular papillary adenocarcinoma of the uterine cervix with aggressive clinical course-a case report[J]. Coll Antropol, 2010, 34:291-294. http://www.ncbi.nlm.nih.gov/pubmed/20437645
    [9] Young RH, Clement PB. Endocervical adenocarcinoma and its variants:their morphology and differential diagnosis[J]. Histopathology, 2002, 41:185-207. doi:  10.1046/j.1365-2559.2002.01462.x
    [10] Fadare O, Zheng W. Well-differentiated papillary villoglandular adenocarcinoma of the uterine cervix with a focal highgrade component:is there a need for reassessment?[J]. Virchows Arch, 2005, 447:883-887. doi:  10.1007/s00428-005-0030-3
    [11] Bouman A, Oosterhuis GJ, Naudin ten Cate L, et al. Villoglandular papillary adenocarcinoma of the cervix. Beware of a wolf in sheep's clothing[J]. Eur J Obstet Gynecol Reprod Biol, 1999, 87:183-189. doi:  10.1016/S0301-2115(99)00106-2
    [12] Takai N, Hayashita C, Nakamura S, et al. A case of villoglandular papillary adenocarcinoma of the uterine cervix diagnosed during early pregnancy followed by successful term delivery[J]. Case Report Med, 2010, 314547. http://europepmc.org/articles/PMC2892664
    [13] Khunamornpong S, Maleemonkol S, Siriaunkgul S, et al. Well-Differentiated villoglandular adenocarcinoma of the uterine cervix:a report of 15 cases including two with lymph node metastasis[J]. J Med Assoc Thai, 2001, 84:882-888. https://www.sciencedirect.com/science/article/pii/S187395981100010X
    [14] Alfsen GC, Kristensen GB, Skovlund E, et al. Histologic subtype has a minor importance for overall survival in patients with adenocarcinoma of the uterine cervix[J]. Cancer, 2001, 92:2471-2483. doi:  10.1002/1097-0142(20011101)92:9<2471::AID-CNCR1597>3.0.CO;2-K
    [15] Kaku T, Kamura T, Shigematsu T, et al. Adenocarcinoma of the uterine cervix with predominantly villoglandular papillary growth pattern[J]. Gynecol Oncol, 1999, 64:147-152. http://www.sciencedirect.com/science/article/pii/S0090825896945394
    [16] Macdonald RD, Kirwan J, Hayat K, et al. Villoglandular adenocarcinoma of the cervix:clarity is needed on the histological definition for this difficult diagnosis[J]. Gynecol Oncol, 2006, 100:192-194. doi:  10.1016/j.ygyno.2005.07.133
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  • 收稿日期:  2011-10-31
  • 刊出日期:  2012-01-30

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