|Table of Contents|

The Analysis of Clinical Diagnosis of CervicalAdenocarcinoma in Situ of 32 Cases(PDF)

《南京师大学报（自然科学版）》[ISSN:1001-4616/CN:32-1239/N]

Issue:
2018年04期
Page:
120-
Research Field:
·生命科学·
Publishing date:

Info

Title:
The Analysis of Clinical Diagnosis of CervicalAdenocarcinoma in Situ of 32 Cases
Author(s):
Fu Yajuan; Liu Juan; Shen Yan
Women’s Hospital of Najing Medical University,Nanjing 210004,China
Keywords:
cervical adenocarcinoma in situ; cytologic screening; High-risk HPV; diagnosis; colposcopy; biopsy; cervical conization
PACS:
R711
DOI:
10.3969/j.issn.1001-4616.2018.04.019
Abstract:
To investigate the clinical diagnostic strategy and treatment method of cervical adenocarcinoma in situ(AIS). The clinical manisestations,diagnostic methods,surgical methods and pathological findings of thirty two cases of cervical adenocarcinoma in situ who treated in our hospital from 2014 to 2017 were analyzed retrospectively. The mean age of the patients was(42.75±7.81)years old,and nine cases showed irregular vaginal bleeding,eight cases showed contact bleeding,twenty one cases had abnormal glandular epithelial cell or squamous epithelial cells,and twenty three cases had high-risk Human Papilloma Virus(HPV)positive(fourteen cases were HPV16、18、45 positive; some of them had two HPV types positive). Twenty nine cases had child/children,three cases had no child. Through out biopsy/endocervical curettage under colposcopy,sixteen cases were diagnosed as AIS,thirteen cases underwent cervical conization and the pathological findings were AIS. Three cases were diagnosed AIS after hysterectomy. Treatment:Of thirty-two patients,six cases underwent directly whole hysterectomy with appendix resection and(or)pelvic lymph node resection,others were performed cervical conization and through out the pathological findings to decide the next clinical operation. A total of twenty nine underwent total hysterectomy,postoperative pathology:eight cases of postoperative pathology AIS,five patients with postoperative pathological cervical adenocarcinoma,one case AIS with suspected micro invasive carcinoma,two cases had focal epithelial dysplasia,two cases were AIS and focal micro infiltrating carcinoma,two cases were CIN1-CIN 2,one case was focal CIN3,one case was AIS combined with CIN2 -CIN3,seven cases just were chronic cervicitis. Metastatic carcinoma was not found in all patients. No recurrence was found during four-forty eight months of postoperative follow-up. Three of the patients chosed conservative treatment of cervical conization,one case of Loop electrosurgical excision(LEEP)surgery found that AIS,conization margin was AIS,the second postoperative pathological of Cold-Knife Conization(CKC)showed CIN2,negative margins,one AIS case diagnosed by biopsy underwent CKC werel chronic cervicitis combined with CIN2,negative margin,one case diagnosed by biopsy of AIS patients with suspected invasive cancer,the first CKC showed AIS,the lesion from the margin recently was about two mm,after the second CKC,postoperative pathologyshowed chronic inflammation,a small gland in mild atypical hyperplasia,pathological glands intracervical margin was about two mm. All the three patients had fertility requirements and were in follow-up. In view of the low sensitivity of cervical cytologic screening and high-risk HPV,slight changes in colposcopy images,lesion size and location,jumping lesions,deep lesions,mixed lesions and other factors will affect the discovery and treatment of AIS. Therefore,the diagnosis of AIS in clinical work should be combined with the comprehensive analysis of cytology and HPV,and at the same time,as a vaginal speculator,we should constantly improve the ability and clinical vigilance to identify adenoepithelial lesions and avoid AIS misdiagnosis,so as to avoid the occurrence of cervical adenocarcinoma as much as possible.

References:

[1] HEPLER T K,DOCKERTY M B,RANDALL L M. Primary adenocarcinoma of the cervix[J]. Am J Obstet Gynecol,1952,63(4):800-808.
[2]FRIEDELL G H,MC K D. Adenocarcinoma in situ of the endocervix[J]. Cancer,1953,6(5):887-897.
[3]鲍冬梅,沈丹华. 宫颈腺上皮肿瘤性病变[J]. 中华病理学,2006,35(12):744-746.
[4]石一复. 《第四版WHO女性生殖器官肿瘤组织学分类》解读[J]. 国际妇产科学,2014,41(6):696-704.
[5]COLGAN T J,LICKRISH G M. The topography and invasive potential of cervical adenocarcinoma in situ,with and without associated squamous dysplasis[J]. Gynecol Oncol,1990,36(2):246-249.
[6]中华预防医学会妇女保健分会. 子宫颈癌综合防控指南[M]. 北京:人民卫生出版社,2008.
[7]OSTOR A G,DUNCAN A,QUINN M,et al. Adenocarcinoma in situ of the uterine cervix:an experience with 100 cases[J]. Gynecol Oncol,2000,79(2):207-210.
[8]POLTRAUER S,REINTHALLER A,HORVAT R,et al. Cervical adenocarcinoma in situ:update and management[J]. Current obstetrics and gynecology reports,2013,2:86-93.
[9]米兰,张岱,毕蕙. 宫颈原位腺癌24例病例报道及文献复习[J]. 中国妇产科临床,2016,3(17):230-231.
[10]SCHOOLLAND M,SEGAL A,ALLPRESS S,et al. Adenocarcinoma in situ of the cervix.sensitivity of detection by smears[J]. Cancer(cancer cytopathol)2003,96(6):330-337.
[11]CULLIMORE J E,LUESLEY D M,ROLLASON T P,et al. A prospective study of conization of the cervix in the management of cervical intraepithelial glandular neoplasia(CIGN)—a preliminary report[J]. Br J Obstet Gynecol 1992,99(4):314-318.
[12]CASTELLAGUE X,DIAZ M. International agency for research on cancer multicerter cancer study group.world-wide human papillomavirus etiology of cervical adenocarcinoma and its cofactors:implications for screening and prevention[J]. J Nat Cancer Inst,2006,98(5):303-315.
[13]MUNOZ N,BOSCH F X. International agency for research on cancer multicenter cervical cancer study group. Epidmiologic classification of human papillomavirus types associated with cervical cancer[J]. N Engl J Med,2003,348(6):518-527.
[14]CHRISTOPHERSON W M,NEALSON N,GRAY L SR. Noninvasive precursor lesions of adenocarcinoma and mixed adenosquamous carcinoma of the cervix uteri[J]. Cancer,1979,44(3):975-983.
[15]ANDERSSON S,MINTS M,WILANDER E. Results of cytology and high risk human papillomavirus testing in females with cervical adenocarcinoma in situ[J]. Oncology letters,2013,6(1):215-219.
[16]PIROG E C,KLETER B,OLGAC S,et al. Prevalence of human papillomavirus DNA in different histological subtypes of cervical adenocarcinoma[J]. Am J Pathol,2000,157(4):1055-1062.
[17]WRIGHT V C. Colposcopy of adenocarcinoma in situ and adenocarcinoma of the uterine cervix:differentiation from other cervical lesions[J]. J Low Genit Tract Dis,1999,3(2):83-97.
[18]WRIGHT V C. Cervical squamous and glandular intraepithelial neoplasia:identification and current management approaches[J]. Salud Publica Mex,2003,45(suppl 3):S417-S429.
[19]WRIGHT V C. Colposcopic features of cervical adenocarcinoma in situ and adenocarcinoma and management of preinvasive disease[C]//Colposcopy—Principles and Practice. Philadelphia,PA:WB Saunders,2001.
[20]WENTZENSEN N,MASSAD L S. Evidence-based consensus recommendations for colposcopy practice for cervical cancer prevention in the United States[J]. J Low Genit Tract Dis,2017,21(4):216-222.
[21]OSTOR A G,PAGANOR,DAVORAN A M. Adenocarcinoma in situ of the cervix[J]. Int J Obstet Gynecol Paghol,1984,3(2):179-190.
[22]WRIGHT T C J R,MASSAD L S,DUNTON C J,et al. 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ[J]. Am J Obstet Gynecol,2007,197(4):340-345.

Memo

Memo:
-
Last Update: 2018-12-30