Jones M A, Young R H
Department of Pathology, Maine Medical Center, Portland 04102, USA.
Am J Surg Pathol. 1996 Nov;20(11):1312-8. doi: 10.1097/00000478-199611000-00002.
Tunnel clusters (TCs) are benign, pseudoneoplastic glandular lesions of the cervix that may be divided into type A (noncystic) and type B (cystic). We report 14 examples of type A TC characterized by a florid proliferation of glands with greater cytologic atypia than normally encountered in this lesion. The majority had been sent for consultation to exclude adenoma malignum (minimal deviation adenocarcinoma). The patients ranged in age from 32 to 54 (mean 44.8) years. Mean gravidity was 2.5 and parity 2.1; all but one patient were multigravid. A history of recent exogenous hormone intake was present in 4 (33%) patients. All of the lesions were incidental findings, and none was associated with a gross abnormality. Microscopically, all were characterized by a lobulated proliferation of predominantly small-caliber, nondilated, closely packed glands frequently arranged around a central primary or secondary endocervical cleft. Most were well circumscribed, but irregular borders created a pseudoinvasive appearance in four cases. The lesions ranged from 2.5 to 7 (mean 3.5 mm) and were frequently associated with type B TC. The glands were lined by either mucinous columnar cells or low cuboidal cells. Cellular crowding with pseudostratification was common, but true stratification or cribriforming was absent. All cases had foci of cytologic atypia including nuclear enlargement, hyperchromasia, prominent nucleoli, and vesicular chromatin. Mitotic activity was absent or inconspicuous. Follow-up in 9 patients (7 treated with hysterectomy, one each with cone biopsy and biopsy only) ranged from 1 to 6 (mean 2.7) years and was uneventful in all of them. Follow-up was unavailable in one, and four were recent cases. Endocervical type A TC with cytologic atypia is a common benign glandular lesion that must be distinguished from adenoma malignum.
隧道状腺体簇（TCs）是子宫颈的良性、假肿瘤性腺性病变，可分为A 型（非囊性）和B 型（囊性）。我们报告了14 例 A 型TC，其特征为腺体呈旺盛增生，细胞学异型性大于该病变通常所见。大多数病例是为排除微偏腺癌（最小偏离腺癌）而送检会诊的。患者年龄在32 至54 岁之间（平均44.8 岁）。平均妊娠次数为2.5 次，产次为2.1 次；除1 例患者外，其余均为多产妇。4 例（33%）患者有近期外源性激素摄入史。所有病变均为偶然发现，且均无大体异常。显微镜下，所有病变均以小叶状增生为主，主要为小口径、未扩张、紧密排列的腺体，常围绕中央原发性或继发性子宫颈管裂隙排列。大多数病变边界清晰，但有4 例边界不规则，呈假浸润外观。病变大小为2.5 至7 毫米（平均3.5 毫米），常与B 型TC 相关。腺体由黏液柱状细胞或低立方细胞衬覆。细胞拥挤伴假复层很常见，但无真正的分层或筛状结构。所有病例均有细胞学异型性灶，包括核增大、核深染、核仁明显和核染色质呈泡状。无有丝分裂活性或不明显。9 例患者（7 例行子宫切除术，1 例行锥形活检，1 例仅行活检）的随访时间为1 至6 年（平均2.7 年），所有患者均无异常。1 例患者未进行随访，4 例为近期病例。伴有细胞学异型性的子宫颈管A型TC 是一种常见的良性腺性病变，必须与微偏腺癌相鉴别。
