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目的探讨宫颈腺癌伴宫颈上皮内瘤变3级(CIN3)的临床病理特点及诊断与鉴别诊断要点。方法对3例宫颈腺癌伴CIN3进行液基细胞学、组织学和免疫组化研究,并复习国内外相关文献。结果 3例宫颈腺癌伴CIN3均发生于中年女性,液基细胞学检查发现原位腺癌伴高级别鳞状上皮内病变,阴道镜检查发现宫颈黏膜不规则病变。宫颈活检提示宫颈腺癌伴CIN3。镜下可见较大区域的腺癌伴小灶CIN3。两部分病变相互独立,一部分可见异型的腺体乳头状、腺管样排列,浸润性生长;另一部分见异型的鳞状上皮核深染,细胞极性和层次消失,累及全层,但未见浸润。免疫组化:两种病变瘤细胞p16、ki-67均阳性。结论宫颈腺癌伴CIN3是较少见的宫颈恶性肿瘤,液基细胞学有助于宫颈肿瘤的早期发现。
Objective To investigate the clinicopathological features and diagnosis and differential diagnosis of cervical adenocarcinoma with cervical intraepithelial neoplasia grade 3 (CIN3). Methods Three cases of cervical adenocarcinoma with CIN3 were studied by liquid-based cytology, histology and immunohistochemistry, and reviewed relevant literature at home and abroad. Results All three cases of cervical adenocarcinoma with CIN3 occurred in middle-aged women. Liquid-based cytology revealed in situ adenocarcinoma with high-grade squamous intraepithelial lesion and colposcopic examination revealed irregular cervical lesions. Cervical biopsy suggests cervical adenocarcinoma with CIN3. Microscope shows a large area of adenocarcinoma with small lesions CIN3. Two parts of the lesion independent of each other, part of the visible abnormal glandular papillary, duct-like arrangement, infiltration of growth; the other part of the see the abnormal squamous cell nuclear stained, cell polarity and the disappearance of the level, involving the whole layer, but no infiltration. Immunohistochemistry: Two kinds of pathological tumor cells p16, ki-67 were positive. Conclusion Cervical adenocarcinoma with CIN3 is a rare cervical cancer, liquid-based cytology contribute to the early detection of cervical cancer.