2007年4月，病史同上，同时做TCT，

TCT见http://www.ipathology.org.cn/forum/forum_display.asp?keyno=16642

 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

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.

名称：图1
描述：图1

名称：图2
描述：图2

宫颈腺癌虽少见，但若是腺癌常见的还是粘液腺癌（又分为宫颈管型（最常见）、肠型、印戒细胞型、微小偏离型、绒毛管状亚型）、子宫内膜样腺癌。

其中绒毛管状亚型：呈树时状分枝结构，类似于结直肠的绒毛管状腺瘤，上皮常为中高分化，细胞柱状，单层或多层排列，散在核分裂，某些细胞内可见粘液分泌（若无粘液，应认为子宫内膜样亚型）。一般年轻女性，可能与口服避孕药有关，常合并CIN或原位腺癌，淋巴结转移少见。本例中，形态很符合，且可见到个别细胞内有粘液成份，故考虑为该诊断。只是不知病人有无相关病史？

学习了

学习了,谢谢