女30岁，接触性出血 - 华夏病理网论坛

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B728女30岁，接触性出血

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楼主发表于 2007-06-27 23:40|举报|关注(0)
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姓名：	×××	性别：	女	年龄：	30
标本名称：	宫颈活检
简要病史：	（2006年10月）女30岁，接触性出血妇检：宫颈赘生物
肉眼检查：	灰白，破碎，总211cm

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标签：宫颈粘液腺癌

本帖最后由于 2007-08-04 19:49:00 编辑

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宫颈粘液腺癌

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1 楼发表于2007-07-23 12:40:00举报|引用
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Glandular tumours and precursors

1 Adenocarcinoma, NOS

2 Mucinous adenocarcinoma

Endocervical

Intestinal

Signet-ring cell

Minimal deviation

Villoglandular 8262/3
WHO内容见12楼。文献多认为预后好，因患者年轻，多建议较保守的外科手术。但亦有报道保守手术后其预后不佳，主要是因为其深部存在浸润性腺癌。这些非常不一致的报道需要全面复习所有文献资料及随访数据。让我们期待最新的一个综述（尚未出版）：Heatley MK. Villoglandular adenocarcinoma of the uterine cervix-a systematic review of the literature.Histopathology. 2007 Jun 26

3 Endometrioid adenocarcinoma

4 Clear cell adenocarcinoma

5 Serous adenocarcinoma

6 Mesonephric adenocarcinoma

7 Adenocarcinoma in situ

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2 楼发表于2007-07-22 23:26:00举报|引用
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本帖最后由于 2007-07-22 23:33:00 编辑 2、

Macdonald RD，……. Villoglandular adenocarcinoma of the cervix: clarity is needed on the histological definition for this difficult diagnosis. Gynecol Oncol. 2006 Jan;100(1):192-4.

BACKGROUND: Villoglandular adenocarcinoma (VGA) of the cervix is reported as a variant of a cervical adenocarcinoma with a good prognosis. CASES: We present two cases histologically reported as a villoglandular adenocarcinoma of the cervix that have recurred and progressed rapidly since initial treatment. External histopathological review suggested both had a prominent villoglandular pattern but with an associated underlying well-differentiated adenocarcinoma. CONCLUSION: The diagnosis of VGA is difficult. Current literature is not entirely consistent in the presented definition, and further clarity is needed. Because of the rarity of VGA and the difficulty but importance of the diagnosis, we would feel that a central review of all cases of VGA is warranted. This would assist in diagnosis and also in obtaining accurate follow-up data.

背景：文献：绒毛腺癌（VGA）是宫颈腺癌的一型，预后好。病例：2例宫颈的绒毛腺癌，治疗后复发。复习原片发现，绒毛腺型为主，但其下方伴有高分化腺癌。结论：VGA难诊断。根据目前的定义，现有文献中的报道并不完全一致，需要进一步明确。因其罕见，确诊难但重要，我们提出需要全面复习所有VGA病例，这将有助于诊断并获得准确的随访数据。F32Y，接触出血，TCT：可疑腺癌细胞。活检：表浅的VGA，正式诊断需要进一步检查，故锥切。4周后锥切：3*3*2CM标本，VGA，最大径24mm，浸润深度2.4mm。切缘均阴性。(Fig. 1)VGA，轻度细胞学异型。建议密切随访而未进一步手术，但3M后发现宫颈明显复发。MRI分期1B2（最大径47mm），宫颈活检示VGA型的高分化腺癌与低分化癌相连续(Fig. 2)。4次顺铂化疗和放疗后，EUA示更广泛的肿瘤扩展，右宫旁累犯(stage 2b)。化疗后快速进展，2M后死亡。 F31Y，出血。宫颈5-6CM外生肿块，无临床parametrial累犯，MRI分期1B2。活检：高分化腺癌伴绒毛腺型。最初采用了化疗，但复习切片后，根据文献VGA预后好，觉得适合手术。子宫根治+盆LN切除。诊断：VGA，浸润深度10MM，淋巴血管隙侵犯，左闭孔淋巴结+。切缘阴性。由于单个LN+，切缘阴性，MDT讨论时未考虑辅助化疗。前3月未发现问题，6月常规复查时发现阴道穹窿可疑病变，活检示VGA的深部浸润。行化放疗，完成后3M复查EUA，阴道穹窿无异常，但引流部位一个淋巴结复发，仍为VGA。切除后化放疗。此后盆腔再次复发，现接受姑息治疗。

名称：图1
描述：图1

名称：图2
描述：图2

2、

Macdonald RD，……. Villoglandular adenocarcinoma of the cervix: clarity is needed on the histological definition for this difficult diagnosis. Gynecol Oncol. 2006 Jan;100(1):192-4.

BACKGROUND: Villoglandular adenocarcinoma (VGA) of the cervix is reported as a variant of a cervical adenocarcinoma with a good prognosis. CASES: We present two cases histologically reported as a villoglandular adenocarcinoma of the cervix that have recurred and progressed rapidly since initial treatment. External histopathological review suggested both had a prominent villoglandular pattern but with an associated underlying well-differentiated adenocarcinoma. CONCLUSION: The diagnosis of VGA is difficult. Current literature is not entirely consistent in the presented definition, and further clarity is needed. Because of the rarity of VGA and the difficulty but importance of the diagnosis, we would feel that a central review of all cases of VGA is warranted. This would assist in diagnosis and also in obtaining accurate follow-up data.

背景：文献：绒毛腺癌（VGA）是宫颈腺癌的一型，预后好。病例：2例宫颈的绒毛腺癌，治疗后复发。复习原片发现，绒毛腺型为主，但其下方伴有高分化腺癌。结论：VGA难诊断。根据目前的定义，现有文献中的报道并不完全一致，需要进一步明确。因其罕见，确诊难但重要，我们提出需要全面复习所有VGA病例，这将有助于诊断并获得准确的随访数据。F32Y，接触出血，TCT：可疑腺癌细胞。活检：表浅的VGA，正式诊断需要进一步检查，故锥切。4周后锥切：3*3*2CM标本，VGA，最大径24mm，浸润深度2.4mm。切缘均阴性。(Fig. 1)VGA，轻度细胞学异型。建议密切随访而未进一步手术，但3M后发现宫颈明显复发。MRI分期1B2（最大径47mm），宫颈活检示VGA型的高分化腺癌与低分化癌相连续(Fig. 2)。4次顺铂化疗和放疗后，EUA示更广泛的肿瘤扩展，右宫旁累犯(stage 2b)。化疗后快速进展，2M后死亡。 F31Y，出血。宫颈5-6CM外生肿块，无临床parametrial累犯，MRI分期1B2。活检：高分化腺癌伴绒毛腺型。最初采用了化疗，但复习切片后，根据文献VGA预后好，觉得适合手术。子宫根治+盆LN切除。诊断：VGA，浸润深度10MM，淋巴血管隙侵犯，左闭孔淋巴结+。切缘阴性。由于单个LN+，切缘阴性，MDT讨论时未考虑辅助化疗。前3月未发现问题，6月常规复查时发现阴道穹窿可疑病变，活检示VGA的深部浸润。行化放疗，完成后3M复查EUA，阴道穹窿无异常，但引流部位一个淋巴结复发，仍为VGA。切除后化放疗。此后盆腔再次复发，现接受姑息治疗。

名称：图1
描述：图1

名称：图2
描述：图2

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3 楼发表于2007-07-22 23:11:00举报|引用
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本帖最后由于 2007-07-22 23:31:00 编辑

为深入学习，提供两个文献。感谢wangzhen_01提供全文。

1、Giovanna Giordano,……. Villoglandular adenocarcinoma of the cervix: two new cases with morphological and molecular study. Int J Gynecol Pathol. 2007 Apr;26(2):199-204.

In this paper, we report 2 new cases of villoglandular papillary adenocarcinoma (VGPA) of the cervix, a rare, well-differentiated form of cervical adenocarcinoma. Both patients were without medical complications or history of oral contraceptive use and were nonsmokers. Extended hysterectomy was performed in both cases. Morphological criteria for a correct pathological diagnosis were emphasized. Immunohistochemical analysis was performed to clarify the phenotype of the neoplasms. Moreover, for the first time, we probed to establish if VGPA could be correlated to human papilloma virus (HPV) and herpes virus (HSV) types 1 and 2, using polymerase chain reaction amplification of tumoral DNA. Both neoplasms showed positivity for B72.3, Ca-125, carcinoembryonic antigen, keratin 7, and p16(INK4a) protein. Vimentin, P53, estrogen, and progesterone receptors, instead, were negative. Molecular study by polymerase chain reaction amplification of tumor DNA revealed a strong positive signal for HPV-DNA and no signal for HSV-DNA. It is reasonable to conclude that our cases of VGPA, in accordance with other examples reported in literature, are due to HPV infection. Behavioral cofactors, such as HSV infection (types 1 and 2), oral contraceptive use and smoking, involved in the pathogenesis of other cervical malignancies, can be excluded for the present cases.

作者报道2例绒毛腺型乳头状腺癌（villoglandular papillary adenocarcinoma, VGPA）。2例均无并发症、无口服避孕药史、无吸烟史，均作子宫扩大切除。强调了正确诊断的形态学标准，通过免疫组化检测明确肿瘤的表型，而且，第一次用PCR法检查是否与HPV和HSV1/2有关。2例均呈B72.3、Ca-125、CEA、CK7和p16阳性，VIM、p53、ER、PR均阴性。PCR呈HPV强阳性，HSV阴性。与文献一致，结果提示VGA与HPV有关。其它辅助因素如：HSV、口服避孕药、吸烟等与宫颈其它恶性肿瘤有关者，与此2例无关。

图示：病变特征为指状或分枝状的乳头，有纤维血管轴心。表覆上皮由复层柱状细胞组成。核圆到拉长（卵圆），呈某种程度复层化及轻到中度异型性（A，HE 100）。浸润性成分，特征为乳头状和腺样，伴促纤维形成性的间质反应（B，HE 200）。

名称：图1
描述：图1

为深入学习，提供两个文献。感谢wangzhen_01提供全文。

1、Giovanna Giordano,……. Villoglandular adenocarcinoma of the cervix: two new cases with morphological and molecular study. Int J Gynecol Pathol. 2007 Apr;26(2):199-204.

In this paper, we report 2 new cases of villoglandular papillary adenocarcinoma (VGPA) of the cervix, a rare, well-differentiated form of cervical adenocarcinoma. Both patients were without medical complications or history of oral contraceptive use and were nonsmokers. Extended hysterectomy was performed in both cases. Morphological criteria for a correct pathological diagnosis were emphasized. Immunohistochemical analysis was performed to clarify the phenotype of the neoplasms. Moreover, for the first time, we probed to establish if VGPA could be correlated to human papilloma virus (HPV) and herpes virus (HSV) types 1 and 2, using polymerase chain reaction amplification of tumoral DNA. Both neoplasms showed positivity for B72.3, Ca-125, carcinoembryonic antigen, keratin 7, and p16(INK4a) protein. Vimentin, P53, estrogen, and progesterone receptors, instead, were negative. Molecular study by polymerase chain reaction amplification of tumor DNA revealed a strong positive signal for HPV-DNA and no signal for HSV-DNA. It is reasonable to conclude that our cases of VGPA, in accordance with other examples reported in literature, are due to HPV infection. Behavioral cofactors, such as HSV infection (types 1 and 2), oral contraceptive use and smoking, involved in the pathogenesis of other cervical malignancies, can be excluded for the present cases.

作者报道2例绒毛腺型乳头状腺癌（villoglandular papillary adenocarcinoma, VGPA）。2例均无并发症、无口服避孕药史、无吸烟史，均作子宫扩大切除。强调了正确诊断的形态学标准，通过免疫组化检测明确肿瘤的表型，而且，第一次用PCR法检查是否与HPV和HSV1/2有关。2例均呈B72.3、Ca-125、CEA、CK7和p16阳性，VIM、p53、ER、PR均阴性。PCR呈HPV强阳性，HSV阴性。与文献一致，结果提示VGA与HPV有关。其它辅助因素如：HSV、口服避孕药、吸烟等与宫颈其它恶性肿瘤有关者，与此2例无关。

图示：病变特征为指状或分枝状的乳头，有纤维血管轴心。表覆上皮由复层柱状细胞组成。核圆到拉长（卵圆），呈某种程度复层化及轻到中度异型性（A，HE 100）。浸润性成分，特征为乳头状和腺样，伴促纤维形成性的间质反应（B，HE 200）。

名称：图1
描述：图1

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华夏病理/粉蓝医疗

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努力让人人享有便捷准确可靠的病理诊断服务。

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4 楼发表于2007-07-07 22:51:00举报|引用
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本帖最后由于 2007-07-07 23:12:00 编辑 此例到周老师那里会诊了，结果基本同12楼。但是LEEP手术标本又有新发现。
据家属发给我的手机短信：
          宫颈环切：
          3',9'-11'：早浸粘液腺癌，深2mm，宽<7mm，
          3'：微浸鳞癌，深1mm，宽2mm，
          余宫颈粘液腺癌。切缘均阴性。
手术是在上海做的，我没图……