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目的探讨宫颈微小偏离性腺癌(MDA)的临床、病理特征。方法对2例宫颈微小偏离性腺癌临床资料进行分析,组织化学及免疫组化(S-P法)检测CEA、CK7、CK8、K i-67、P53,并结合文献进行复习。结果MDA多见于中老年人,病程6个月至3年不等,预后较差。临床表现主要为白带增多或阴道流水样液,可伴阴道不规则出血。妇检:宫颈肥大,表面糜烂或颗粒状,质硬;宫颈管扩张,可呈桶状。术前临床及病理易误诊为慢性宫颈炎。镜下:MDA分化程度高,瘤组织形态和正常颈管腺体差异微小,腺体结构呈奇异性分支和成角浸润,少见背靠背现象;瘤细胞异型性小,可见个别胞核轻中度增大或核上移,核分裂像无或极少见。浸润深度达宫颈壁的2/3(或7 mm以上),间质可见血管及神经侵犯。可向上侵犯宫腔及淋巴结转移。腺周间质可见不同程度的组织反应及炎细胞浸润。组织化学PAS阳性。免疫组化CEA、CK7、CK8、K i-67瘤细胞阳性P53蛋白阴性。结论MDA是一种较为少见的特殊类型的子宫颈腺癌。
Objective To investigate the clinical and pathological features of cervical micro deviated adenocarcinoma (MDA). Methods The clinical data of 2 patients with minimally invasive cervical adenocarcinoma were analyzed. The expressions of CEA, CK7, CK8, K i-67 and P53 were detected by histochemical and immunohistochemical methods (S-P method). Results MDA more common in the elderly, duration of 6 months to 3 years, the prognosis is poor. The main clinical manifestations of leucorrhea increase or vaginal fluid sample may be accompanied by irregular vaginal bleeding. Gynecological examination: cervical hypertrophy, surface erosion or granular, hard; cervical canal dilation, can be barrel-shaped. Preoperative clinical and pathological misdiagnosis as chronic cervicitis. Microscopically, MDA had a high degree of differentiation, with slight difference between the morphology of the tumor and the normal glandular tube. The glandular structure was singularly branched and infiltrated into the cornea, with rare back-to-back phenomenon. Large or nuclear shift, mitotic or none rare. Invasive depth of cervical wall 2/3 (or more than 7 mm), interstitial vascular and nerve violations can be seen. Upward violation of uterine cavity and lymph node metastasis. Glandular cytoplasm can be seen varying degrees of tissue response and inflammatory cell infiltration. Histochemical PAS positive. Immunohistochemical CEA, CK7, CK8, Ki-67 tumor cells positive P53 protein negative. Conclusion MDA is a rare and special type of cervical adenocarcinoma.