Costa M J, McIlnay K R, Trelford J
Department of Pathology, University of California, Davis, Medical Center, Sacramento 95817, USA.
Hum Pathol. 1995 Aug;26(8):829-37. doi: 10.1016/0046-8177(95)90003-9.
Pathologists confront questions concerning the clinical implications of the more complex, evolving histopathologic classification in cervical carcinoma with glandular differentiation (CCGD) and the associated precursor intraepithelial lesions. Pseudoneoplastic pitfalls, such as microglandular hyperplasia, constitute the subject of recent reports, but the extent of misinterpretation for CCGD is unknown. To address these issues, we retrospectively reviewed all the histopathologic material for 67 patients treated for early clinical stage (I or II) CCGD. Two patients (3%) had pseudoneoplastic glandular lesions (two microglandular hyperplasias). The remaining 65 CCGDs included 35 pure adenocarcinomas (18 mucinous, six serous, five endometrioid, five clear cell, and one adenoid cystic), 26 adenosquamous carcinomas (17 showed > or = 50% and nine showed > 10% but < 50% squamous differentiation-all nonkeratinizing; four were predominantly glassy cell type, and the others showed the following adenocarcinoma component differentiation: 11 mucinous, eight serous, and three endometrioid) and four villoglandular papillary adenocarcinomas (all four were mucinous). In situ carcinoma was identified in 54%. The two patients with pseudoneoplastic lesions were disease free (after 96 and 108 months). Twenty-one patients with CCGD had recurrent disease at 4 to 144 months (mean, 45; median, 18) including three local recurrences, 10 with distant metastasis, and eight with both. Thirty-five patients with CCGD were disease free at 12 to 216 months follow-up (mean, 80.6; median, 65). Adenosquamous (P < .0002, predictive value [PV] = .68) and serous differentiation (P < .05, PV = .61) were the only histological types associated with disease recurrence. Vascular space invasion (P < .0002, PV = .7), deeper invasion (P < .0005), nuclear grade (P = .002, PV = .51), larger tumors on clinical exam (P < .01) or pathological evaluation (P < .01), and presence of pelvic lymph node metastasis at surgery (P < .05, PV = .7) are additional features associated with recurrent disease. A combination of adenosquamous or serous differentiation and vascular space invasion maximized PV for recurrent disease at a level of .75. Mucinous, endometrioid, or clear cell histological types, architectural grade, or the distinction between clinical stages I and II were not associated with recurrent disease. None of the four patients with villoglandular papillary adenocarcinoma exhibited recurrent disease, but confirmation of this histological subtype's prognostic value was hindered by the small number of cases identified (P = .16). Adenosquamous and serous differentiation, nuclear grading, pathological evaluation of vascular space and lymph node involvement, and recognition of pseudoneoplastic glandular lesions helped predict recurrent disease in low clinical stage CCGD in this retrospective study.
病理学家面临着有关宫颈腺癌伴腺分化（CCGD）及其相关的上皮内前驱病变中更复杂、不断演变的组织病理学分类的临床意义的问题。诸如微腺增生等假肿瘤性陷阱是近期报告的主题，但CCGD的误诊程度尚不清楚。为了解决这些问题，我们回顾性分析了67例早期临床分期（I期或II期）CCGD患者的所有组织病理学资料。两名患者（3%）有假肿瘤性腺性病变（两例微腺增生）。其余65例CCGD包括35例纯腺癌（18例黏液性、6例浆液性、5例子宫内膜样、5例透明细胞和1例腺样囊性）、26例腺鳞癌（17例鳞状分化≥50%，9例鳞状分化＞10%但＜50%——均为非角化型；4例主要为玻璃样细胞型，其他病例显示以下腺癌成分分化：11例黏液性、8例浆液性和3例子宫内膜样）和4例绒毛腺性乳头状腺癌（4例均为黏液性）。原位癌的检出率为54%。两名有假肿瘤性病变的患者无病生存（分别为96个月和108个月后）。21例CCGD患者在4至144个月（平均45个月；中位数18个月）出现疾病复发，包括3例局部复发、10例远处转移和8例两者皆有。35例CCGD患者在12至216个月的随访中无病生存（平均80.6个月；中位数65个月）。腺鳞癌（P＜0.0002，预测值[PV]=0.68）和浆液性分化（P＜0.05，PV=0.61）是与疾病复发相关的唯一组织学类型。血管间隙侵犯（P＜0.0002，PV=0.7）、更深的侵犯（P＜0.0005）、核分级（P=0.002，PV=0.51）、临床检查（P＜0.01）或病理评估（P＜0.01）时更大的肿瘤，以及手术时盆腔淋巴结转移的存在（P＜0.05，PV=0.7）是与疾病复发相关的其他特征。腺鳞癌或浆液性分化与血管间隙侵犯的组合使复发疾病的PV最大化，达到0.75。黏液性、子宫内膜样或透明细胞组织学类型、结构分级，或临床I期和II期之间的区别与疾病复发无关。4例绒毛腺性乳头状腺癌患者均未出现疾病复发，但由于所识别的病例数量较少，妨碍了对该组织学亚型预后价值的确认（P=0.16）。在这项回顾性研究中，腺鳞癌和浆液性分化、核分级、血管间隙和淋巴结受累的病理评估，以及对假肿瘤性腺性病变的识别有助于预测低临床分期CCGD的疾病复发。
