Ding Dah-Ching, Chu Tang-Yuan, Hsu Yung-Hsiang
Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
Tzu Chi Med J. 2016 Apr-Jun;28(2):79-81. doi: 10.1016/j.tcmj.2014.10.001. Epub 2014 Nov 24.
Minimal deviation adenocarcinoma (MDA) of the uterine cervix is a rare disease. The rate of misdiagnosis is relatively high and there is no standard treatment. A 58-year-old woman presented with an abnormal Pap smear revealing atypical glandular cells and vaginal mucoid discharge. Cervical biopsy revealed cervicitis and an endometrium with atypical glands and increasing mitoses. A frozen section of curetted endometrial tissue revealed adenocarcinoma. Surgical staging with laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic lymph node dissection was then performed. However, uterine cervical MDA was confirmed by pathology and immunohistochemistry with carcinoembryonic antigen and vimentin. Because the staging surgery was inadequate (the parametrium was not radically resected), postoperative adjuvant therapy with concurrent chemoradiation was performed. The patient remained disease-free as of the last follow-up 6 months postoperatively. MDA is difficult to diagnose and depends on its clinical manifestations and pathologic features. Surgery with adjuvant chemoradiotherapy achieves good outcomes.
子宫颈微小偏离性腺癌（MDA）是一种罕见疾病。误诊率相对较高且没有标准治疗方法。一名58岁女性因巴氏涂片异常，显示非典型腺细胞和阴道黏液样分泌物就诊。宫颈活检显示宫颈炎，子宫内膜有非典型腺体且有丝分裂增加。刮宫子宫内膜组织的冰冻切片显示为腺癌。随后进行了腹腔镜子宫切除术、双侧输卵管卵巢切除术和双侧盆腔淋巴结清扫的手术分期。然而，病理检查及癌胚抗原和波形蛋白免疫组化确诊为子宫颈MDA。由于分期手术不充分（未彻底切除子宫旁组织），术后进行了同步放化疗的辅助治疗。截至术后6个月的最后一次随访，患者无疾病复发。MDA难以诊断，依赖于其临床表现和病理特征。手术联合辅助放化疗可取得良好疗效。
