Nara Masatoshi, Hashi Akihiko, Murata Shin-Ichi, Kondo Tetsuo, Yuminamochi Tsutomu, Nakazawa Kumiko, Katoh Ryohei, Hoshi Kazuhiko
Department of Obstetrics and Gynecology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan.
Gynecol Oncol. 2007 Aug;106(2):289-98. doi: 10.1016/j.ygyno.2007.03.044. Epub 2007 May 30.
The aim of this study was to investigate differences in the process of carcinogenesis between adenocarcinoma coexistent with LEGH and conventional adenocarcinoma. And we intend to describe appropriate treatment plans for LEGH in this study.
Using the surgical pathology files of patients who visited the University of Yamanashi Hospital, Yamanashi Central Hospital and Kofu Municipal Hospital between 1996 and 2005, pathological diagnoses were reevaluated based on criteria for the diagnosis of LEGH by Nucci et al. As for the cases including adenocarcinoma with LEGH: (a) we created a map showing position of the LEGH component and adenocarcinoma component and squamo-columnar junction (SCJ) in HE-stained specimens, (b) immunohistochemical staining was performed using antibodies to CEA, HIK1083 and p53, and (c) detection of HPV DNA was performed using PCR and in situ hybridization (ISH).
Endocervical adenocarcinoma was observed coexistent with LEGH in 5 cases (19.2%). (a) LEGH was located in a remote place from the SCJ. Sizes of lesions in the 5 cases ranged from 18 to 35 mm in width and 7 to 16 mm in depth. (b) HIK1083 was diffusely immunopositive in the cytoplasm of LEGH component and focal immunopositive in 4 cases with adenocarcinoma component. Immunopositivity for CEA was seen in the cytoplasm of adenocarcinoma component in 4 cases. Immunopositivity for p53 was seen in adenocarcinoma component nuclei in 2 cases. (c) HPV DNA was not detected using PCR and ISH in either LEGH or adenocarcinoma components.
The present study suggests that clear differences exist in the process of carcinogenesis between adenocarcinoma associated with LEGH and conventional adenocarcinoma. LEGH may represent a precursor of cervical adenocarcinoma independent of HPV infection. As LEGH displays characteristics of precancerous mucinous adenocarcinoma, surgical treatment should be considered for LEGH growing beyond a certain size.
本研究旨在探讨伴有低级别子宫内膜样腺化生（LEGH）的腺癌与传统腺癌在致癌过程中的差异。并且我们打算在本研究中描述针对LEGH的合适治疗方案。
利用1996年至2005年间到山梨大学医院、山梨中央医院和甲府市立医院就诊患者的手术病理档案，根据Nucci等人关于LEGH的诊断标准对病理诊断进行重新评估。对于包括伴有LEGH的腺癌的病例：（a）我们制作了一张显示HE染色标本中LEGH成分、腺癌成分和鳞柱状交界（SCJ）位置的图谱，（b）使用抗CEA、HIK1083和p53抗体进行免疫组化染色，（c）使用PCR和原位杂交（ISH）检测HPV DNA。
5例（19.2%）观察到宫颈内膜腺癌与LEGH共存。（a）LEGH位于远离SCJ的位置。5例病变宽度为18至35毫米，深度为7至16毫米。（b）HIK1083在LEGH成分的细胞质中呈弥漫性免疫阳性，在4例腺癌成分中呈局灶性免疫阳性。4例腺癌成分的细胞质中可见CEA免疫阳性。2例腺癌成分细胞核中可见p53免疫阳性。（c）在LEGH或腺癌成分中，使用PCR和ISH均未检测到HPV DNA。
本研究表明，伴有LEGH的腺癌与传统腺癌在致癌过程中存在明显差异。LEGH可能代表独立于HPV感染的宫颈腺癌前体。由于LEGH表现出癌前黏液腺癌的特征，对于生长超过一定大小的LEGH应考虑手术治疗。
