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,FI...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5～25mm;4例呈乳头状或细绒毛样粗糙区,面积25mm×14mm至35mm×20mm;1例术后转移病例表现为溃疡型肿物,直径25mm。镜下肿瘤浸润深度2～12mm,浸润宽度5～26mm,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 neoplasiaIII,CINIII)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。展开更多
Background:Villoglandular adenocarcinoma of the cervix is a rare neoplasm associated with a favorable outcome.It can be managed conservatively even when complicated by pregnancy.This is the first report in China of vi...Background:Villoglandular adenocarcinoma of the cervix is a rare neoplasm associated with a favorable outcome.It can be managed conservatively even when complicated by pregnancy.This is the first report in China of villoglandular adenocarcinoma complicated with pregnancy.Method of the management was discussed.Case:A privida at 35 weeks gestation was found to have a large,friable,cauliflower like lession.Pathology revealed villoglandular adenocarcinoma.She was dilivered a healthy baby at 36 weeks’ gestation by cesarean section,then a radical hysterectomy and pelvic periaortic lymphadenectomies were performed.The patient remains well at 6 months follow-up.Conclution: villoglandular adenocarcinoma of the cervix has a faverable prognosis and can be managed conservatively,even when coplicated by pregnancy.展开更多
为探讨宫颈绒毛腺管状腺癌(villoglandular adenocarcinoma,VGA)的临床特征、病理学特征、免疫表型、鉴别诊断、治疗及预后,应用光学显微镜及免疫组织化学方法分析9例VGA病例的临床病理特点及免疫表型,并复习相关文献。9例VGA患者年龄39...为探讨宫颈绒毛腺管状腺癌(villoglandular adenocarcinoma,VGA)的临床特征、病理学特征、免疫表型、鉴别诊断、治疗及预后,应用光学显微镜及免疫组织化学方法分析9例VGA病例的临床病理特点及免疫表型,并复习相关文献。9例VGA患者年龄39～62(平均50.8)岁。临床表现多为阴道不规则出血或月经异常,阴道镜下6例为宫颈外生性肿块,3例为宫颈糜烂。HPV检测多为阳性。显微镜下肿瘤具有大量长而细的绒毛状腺管结构,大部分乳头含有中央纤维血管轴心,由梭形间质细胞和多少不等的炎细胞组成;肿瘤细胞低柱状,核圆形,轻中度的细胞异型性,其中7例浸润<1/3纤维肌层。9例VGA中仅1例累及子宫内膜,其余8例均未侵犯神经脉管及周围器官组织。有1例患者部分区域可见原位腺癌成分。免疫表型:肿瘤细胞CEA和p16均呈阳性,不表达Vimentin,少数肿瘤细胞表达ER和PR,Ki-67 LI 30%～90%。VGA是一种少见的宫颈腺癌,难以通过临床表现进行区分,要依据其病理组织学特点,结合免疫组织化学染色明确诊断,该病预后较好,故需谨慎排查防止医疗过度。展开更多
文摘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5～25mm;4例呈乳头状或细绒毛样粗糙区,面积25mm×14mm至35mm×20mm;1例术后转移病例表现为溃疡型肿物,直径25mm。镜下肿瘤浸润深度2～12mm,浸润宽度5～26mm,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 neoplasiaIII,CINIII)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。
文摘Background:Villoglandular adenocarcinoma of the cervix is a rare neoplasm associated with a favorable outcome.It can be managed conservatively even when complicated by pregnancy.This is the first report in China of villoglandular adenocarcinoma complicated with pregnancy.Method of the management was discussed.Case:A privida at 35 weeks gestation was found to have a large,friable,cauliflower like lession.Pathology revealed villoglandular adenocarcinoma.She was dilivered a healthy baby at 36 weeks’ gestation by cesarean section,then a radical hysterectomy and pelvic periaortic lymphadenectomies were performed.The patient remains well at 6 months follow-up.Conclution: villoglandular adenocarcinoma of the cervix has a faverable prognosis and can be managed conservatively,even when coplicated by pregnancy.
文摘为探讨宫颈绒毛腺管状腺癌(villoglandular adenocarcinoma,VGA)的临床特征、病理学特征、免疫表型、鉴别诊断、治疗及预后,应用光学显微镜及免疫组织化学方法分析9例VGA病例的临床病理特点及免疫表型,并复习相关文献。9例VGA患者年龄39～62(平均50.8)岁。临床表现多为阴道不规则出血或月经异常,阴道镜下6例为宫颈外生性肿块,3例为宫颈糜烂。HPV检测多为阳性。显微镜下肿瘤具有大量长而细的绒毛状腺管结构,大部分乳头含有中央纤维血管轴心,由梭形间质细胞和多少不等的炎细胞组成;肿瘤细胞低柱状,核圆形,轻中度的细胞异型性,其中7例浸润<1/3纤维肌层。9例VGA中仅1例累及子宫内膜,其余8例均未侵犯神经脉管及周围器官组织。有1例患者部分区域可见原位腺癌成分。免疫表型:肿瘤细胞CEA和p16均呈阳性,不表达Vimentin,少数肿瘤细胞表达ER和PR,Ki-67 LI 30%～90%。VGA是一种少见的宫颈腺癌,难以通过临床表现进行区分,要依据其病理组织学特点,结合免疫组织化学染色明确诊断,该病预后较好,故需谨慎排查防止医疗过度。
