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背景与目的:宫颈微偏腺癌(minimal deviation adenocarcinoma of cervix,MDA)是一种罕见疾病,误诊率较高,尚无规范的治疗方法。本研究旨在分析总结MDA的临床病理特点,以提高对该病的认识。方法:回顾性分析嘉兴市妇幼保健院2006年6月至2009年6月诊治的8例MDA患者的临床病理资料。结果:8例患者的中位年龄53岁(50~56岁)。主要临床表现为大量稀薄粘液性白带、阴道不规则出血等。MDA在组织学上表现肿瘤腺上皮细胞近似正常宫颈腺上皮,细胞异形性不明显,但浸润深度超过5mm。免疫组化示2例患者癌胚抗原(CEA)和P53阳性。8例患者接受手术治疗,其中手术+放疗3例,手术+化疗+放疗1例,单纯手术治疗3例,1例外院治疗,随访1~20个月,失访病例1例,7例患者随访20个月均无瘤生存。结论:可通过临床表现、宫颈和颈管的深层活检(>5mm)或宫颈锥切、MRI、免疫组化等综合手段提高MDA的初筛率;腺体浸润深度超过正常宫颈腺体深度的病理特点作为诊断依据;以手术为主的综合治疗可能是治疗MDA的较好方法。
BACKGROUND & OBJECTIVE: Minimal deviation of adenocarcinoma of cervix (MDA) is a rare disease with high misdiagnosis rate and no standardized treatment. The purpose of this study is to analyze and summarize the clinical and pathological features of MDA in order to improve the understanding of the disease. Methods: The clinicopathological data of 8 patients with MDA who were diagnosed and treated in Jiaxing MCH from June 2006 to June 2009 were retrospectively analyzed. Results: The median age of 8 patients was 53 years (50 to 56 years). The main clinical manifestations of a large number of thin leucorrhea vaginal discharge, irregular vaginal bleeding. Histologically, MDA showed normal epithelial glandular epithelial cells in the glandular epithelium. The abnormality of cells was not obvious, but the depth of invasion was more than 5mm. Immunohistochemistry showed two cases of carcinoembryonic antigen (CEA) and P53 positive. Eight patients underwent surgery, including 3 cases of surgery plus radiotherapy, 1 case of surgery plus chemotherapy plus radiotherapy, 3 cases of simple surgery, 1 case of out-hospital treatment, 1 to 20 months of follow-up, 1 case of failed follow-up and 7 cases of follow-up Tumor-free survival in 20 months. Conclusions: The primary screening rate of MDA can be increased by clinical manifestations, deep biopsy (> 5mm) of cervical and cervical canal or conization of the cervix, MRI, immunohistochemistry and so on. The pathological changes of glandular infiltration more than the depth of normal cervical gland Characteristics as a basis for diagnosis; surgery-based comprehensive treatment may be a better way to treat MDA.