Preoperative Differential Diagnosis of Minimal Deviation Adenocarcinoma and Lobular Endocervical Glandular Hyperplasia of the Uterine Cervix A Multicenter Study of Clinicopathology and Magnetic Resonance Imaging Findings
Preoperative Differential Diagnosis of Minimal Deviation Adenocarcinoma and Lobular Endocervical Glandular Hyperplasia of the Uterine Cervix A Multicenter Study of Clinicopathology and Magnetic Resonance Imaging Findings
复制标题
DOI：
10.1097/igc.0b013e31821f746c
复制
发表时间：
2011-10-01
影响因子：
4.8
通讯作者：
Konishi, Ikuo
中科院分区：
文献类型：
--
作者：
Takatsu, Akiko;Shiozawa, Tanri;Konishi, Ikuo
目的：通过多中心研究，探讨微小偏离性腺癌（MDA）和小叶型颈内腺增生（LEGH）的术前鉴别诊断和治疗方法。方法：收集来自24家医院的112例因疑似丙二醛而行宫颈锥切或子宫切除术的患者。每个病例的病理诊断由中央病理审查委员会确定。分析临床病理表现（包括磁共振成像（MRI）、巴氏涂片（Pap）和胃粘蛋白检测）的诊断意义。结果：中央病理复查发现Nabothian囊肿或隧道簇状病变37例，LEGH 54例，MDA 6例，腺癌11例，良性病变4例。小叶宫颈内腺增生常与原位腺癌、MDA和粘液腺癌相关。三名MDA患者有复发，而LEGH患者没有复发，与手术类型无关。在MRI上，LEGH表现为特征性的多囊性病变，内有实性成分，而MDA则以实性为主。单独的子宫颈抹片检查或胃黏液检查诊断能力有限。然而，这些发现的结合是有用的；也就是说，MRI显示囊性结构内实性成分与轻度腺非典型性和胃粘蛋白相关，强烈提示LEGH（24/ 26,92%）。实性结构伴非典型腺细胞提示丙二醛或腺癌（5/ 5,100 %）。结论：MRI、巴氏涂片、胃粘蛋白联合检查可提高术前诊断MDA和LEGH的准确性。怀疑患有LEGH的患者可能需要采用不那么激进的方法进行治疗。
Objective: To clarify the preoperative differential diagnosis and management of minimal deviation adenocarcinoma (MDA) and lobular endocervical glandular hyperplasia (LEGH), a multicenter study was performed.Methods: A total of 112 patients who underwent conization or a hysterectomy for suspected MDA were collected from 24 hospitals. The pathological diagnosis in each case was determined by a central pathological review board. The diagnostic significance of clinicopathologic findings including results of magnetic resonance imaging (MRI), Papanicolaou (Pap) smears, and testing for gastric mucin was analyzed.Results: The central pathological review identified 37 cases of Nabothian cyst or tunnel cluster, 54 cases of LEGH, 6 cases of MDA, 11 cases of adenocarcinoma, and 4 cases of benign disease. Lobular endocervical glandular hyperplasia was often associated with adenocarcinoma in situ, MDA, and mucinous adenocarcinoma. Three MDA patients had a recurrence, whereas none of LEGH patients had a recurrence irrespective of the type of surgery. On MRI, LEGH appeared as a characteristic multicystic lesion with an inner solid component, whereas MDA showed a predominantly solid pattern. A Pap smear or gastric mucin alone had limited diagnostic power. However, a combination of these findings is useful; that is, a cystic structure with inner solid components on MRI associated with mild glandular atypia and gastric mucin strongly suggested LEGH (24/26, 92%). A solid structure with atypical glandular cells was indicative of MDA or adenocarcinoma (5/5, 100%).Conclusions: The combination of MRI, Pap smears, and gastric mucin will improve the accuracy of the preoperative diagnosis of MDA and LEGH. Patients suspected of having LEGH may need to be treated with less aggressive methods.