Goldstein N S, Ahmad E, Hussain M, Hankin R C, Perez-Reyes N
Department of Anatomic Pathology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Am J Clin Pathol. 1998 Aug;110(2):200-9. doi: 10.1093/ajcp/110.2.200.
Some believe endocervical glandular atypia (EGA), purportedly composed of cells that are less atypical than cells of adenocarcinoma in situ (AIS), is a preneoplastic precursor of AIS. We examined 246 neoplastic and nonneoplastic cervical cone biopsy and hysterectomy specimens from 221 patients for lesions composed of glandular cells with less atypia than AIS to define and characterize their association with other glandular processes. To avoid the circular argument of high-grade EGA (dysplasia) vs AIS, we set the minimum degree of AIS cells as the degree of atypia of the cells constituting a moderately differentiated invasive adenocarcinoma. Only 4 endocervical glandular lesions with mild atypia were found, 3 in patients with AIS or invasive endocervical-primary adenocarcinoma and 1 in a patient with invasive endometrial-primary, adenocarcinoma with endocervical extension. There were no lesions with high-grade atypia, nor was there a morphologic spectrum of cells with less atypia than AIS. Of the specimens, 14% had benign endocervical cell changes. The percentage of specimens in each group with benign endocervical cell changes was approximately equal. Although our study is small and retrospective, it suggests that no morphologic evidence exists to support the existence of a spectrum of endocervical glandular changes that culminates in AIS.
一些人认为，宫颈管腺上皮异型增生（EGA）据称由比原位腺癌（AIS）细胞异型性更小的细胞组成，是AIS的肿瘤前体。我们检查了来自221例患者的246份肿瘤性和非肿瘤性宫颈锥形活检及子宫切除标本，以寻找由比AIS异型性更小的腺细胞组成的病变，从而确定并描述它们与其他腺性病变的关联。为避免高级别EGA（发育异常）与AIS之间的循环论证，我们将AIS细胞的最小异型程度设定为构成中分化浸润性腺癌的细胞异型程度。仅发现4例宫颈管腺性病变有轻度异型性，3例发生于AIS或浸润性宫颈原发性腺癌患者，1例发生于浸润性子宫内膜原发性腺癌伴宫颈管浸润的患者。没有发现高级别异型性的病变，也没有发现比AIS异型性更小的细胞形态学谱系。在这些标本中，14%有宫颈管良性细胞改变。每组中有宫颈管良性细胞改变的标本百分比大致相等。尽管我们的研究规模小且为回顾性研究，但它表明没有形态学证据支持存在一系列最终发展为AIS的宫颈管腺性改变。
