Sauder Kenan, Wilbur David C, Duska Linda, Tambouret Rosemary H
Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
Diagn Cytopathol. 2009 Jun;37(6):437-42. doi: 10.1002/dc.21052.
Radical trachelectomy (RT) is the surgical amputation of the uterine cervix with paracervical lymphadenectomy, performed in reproductive age women to treat invasive squamous-cell carcinoma or endocervical adenocarcinoma while preserving the uterine corpus for potential child bearing. Post-RT patient monitoring includes isthmic-vaginal cytology. This study reviews our experience with liquid based preparation of post-RT cytology samples. Fifty-four post-RT vaginal-isthmic cytology specimens were reviewed from nine patients, seven with adenocarcinoma, and two with squamous-cell carcinoma. Five patients had normal (NILM) or normal with reactive changes on all cytology samples. Two patients had isolated squamous abnormalities (atypical squamous-cells of uncertain significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL)); both follow-up biopsies were negative. Two patients had repeatedly abnormal specimens interpreted as atypical glandular cells (AGC), one of whom also had a concurrent ASC-US. Only one sample was tested for high risk human papilloma virus (hrHPV), with negative results. All patients with abnormal cytology went on to have biopsies which were interpreted as benign. The cytology specimens most often interpreted as AGC contained many groups of hyperchromatic crowded glandular cells and/or stromal cells derived from direct sampling of the lower uterine segment. The crowding often limits visualization of all the cells in a group, plus sampled endometrium may harbor mitoses, adding to the atypical appearance. Cytologists should become familiar with the spectrum of changes in the post-RT cytology. Testing for hrHPV should be considered for use in the management of abnormal cytology results. Post RT cytology should be compared with presurgical cytology since one would anticipate similarities in post-RT true positive cases. In particular, a primary diagnosis of adenocarcinoma makes differentiating benign reactive glandular cells from recurrence a critical issue.
根治性宫颈切除术（RT）是指切除子宫颈并进行宫旁淋巴结清扫术，该手术针对育龄期女性，用于治疗浸润性鳞状细胞癌或宫颈管腺癌，同时保留子宫体以实现潜在的生育功能。RT术后患者监测包括峡部-阴道细胞学检查。本研究回顾了我们对RT术后细胞学样本液基制片的经验。我们对9例患者的54份RT术后阴道-峡部细胞学标本进行了回顾，其中7例为腺癌，2例为鳞状细胞癌。5例患者的所有细胞学样本均为正常（未见上皮内病变或恶性病变，NILM）或有反应性改变的正常情况。2例患者有孤立的鳞状上皮异常（意义不明确的非典型鳞状细胞，ASC-US和低级别鳞状上皮内病变，LSIL）；两次随访活检结果均为阴性。2例患者的标本反复异常，被解读为非典型腺细胞（AGC），其中1例同时伴有ASC-US。仅1份样本检测了高危型人乳头瘤病毒（hrHPV），结果为阴性。所有细胞学异常的患者均接受了活检，活检结果均为良性。最常被解读为AGC的细胞学标本包含许多组深染、拥挤的腺细胞和/或源自子宫下段直接取样的基质细胞。细胞拥挤常常限制了一组中所有细胞的观察，此外，取样的子宫内膜可能含有有丝分裂象，增加了非典型外观。细胞学家应熟悉RT术后细胞学变化的范围。对于异常细胞学结果的处理，应考虑进行hrHPV检测。RT术后细胞学应与术前细胞学进行比较，因为预计RT术后的真阳性病例会有相似之处。特别是，腺癌的初步诊断使得区分良性反应性腺细胞与复发成为一个关键问题。
