Diagnostic significance of endocervical glandular cells with "golden-yellow" mucin on pap smear
Diagnostic significance of endocervical glandular cells with "golden-yellow" mucin on pap smear
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DOI：
10.1002/dc.10140
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发表时间：
2002-08-01
影响因子：
1.3
通讯作者：
Manabe, T
中科院分区：
文献类型：
--
作者：
Hata, S;Mikami, Y;Manabe, T
宫颈内腺细胞在Papanicolaou技术下很少显示“金黄色”黏液染色，而恶性腺瘤（小偏差腺癌）细胞却可以。为了进一步评估这一发现的意义，我们回顾了6例含有金黄色粘蛋白的非典型腺细胞的巴氏涂片。子宫切除标本镜检证实1例为恶性腺瘤，其余5例诊断为宫颈内腺增生伴幽门腺化生。6例腺体细胞均可见金黄色粘蛋白。在恶性腺瘤的病例中，细胞核更大，染色质质地粗颗粒状，尽管很难区分恶性腺瘤和五种良性病变。在所有病例的组织切片上进行的特殊染色表明，在幽门腺化生和恶性腺瘤的部分腺体细胞的胞浆内粘蛋白主要是pas阳性，并显示出对M-GGMC-1 （HIK1083）的免疫反应性，该蛋白与胃幽门腺粘蛋白反应。对1165个连续的巴氏涂片的回顾未能识别出带有金黄色黏液的细胞。这些观察结果表明，Papanicolaou涂片上的金黄色粘蛋白似乎代表了宫颈内腺细胞的胃表型，这是恶性腺瘤和幽门腺化生所共有的独特特征。因此，这一发现应被视为一个警告信号，提高了恶性腺瘤的可能性，需要及时的组织病理学评估，尽管它本身不是恶性肿瘤的诊断。
Endocervical glandular cells rarely show "golden-yellow" mucin staining using the Papanicolaou technique, whereas the cells of adenoma malignum (minimal deviation adenocarcinoma) do. To further evaluate the significance of this finding, we reviewed the Pap smears of six cases in which atypical glandular cells containing golden-yellow mucin was identified. Microscopic examination of the hysterectomy specimens confirmed one case of adenoma malignum, whereas the other five cases were diagnosed as endocervical glandular hyperplasia with pyloric gland metaplasia. Glandular cells observed in all six cases were filled with golden-yellow mucin. In the case of adenoma malignum the nuclei were somewhat more enlarged and the chromatin texture was coarsely granular, although a distinction between adenoma malignum and the five benign lesions was difficult. Special staining performed on tissue sections in all cases demonstrated that the intracytoplasmic mucin of the glandular cells in portion of both pyloric gland metaplasia and adenoma malignum was predominantly PAS-positive and showed immunoreactivity for M-GGMC-1 (HIK1083), which reacts with pyloric gland mucin of the stomach. A review of 1, 165 consecutive Pap smears failed to identify cells with golden-yellow mucin. These observations indicate that golden-yellow mucin on Papanicolaou smear seems to represent a gastric phenotype of endocervical glandular cells, which is a unique characteristic shared by adenoma malignum and pyloric gland metaplasia. This finding should therefore be regarded as a warning sign, raising the possibility, of adenoma malignum and requiring prompt histopathologic assessment, although not of itself diagnostic of malignancy.