Brainard J A, Hart W R
Department of Anatomic Pathology, The Cleveland Clinic Foundation, Ohio 44195, USA.
Am J Surg Pathol. 1998 Aug;22(8):965-75. doi: 10.1097/00000478-199808000-00006.
A series of 12 adenoid basal carcinomas and three adenoid basal hyperplasias of the cervix were analyzed. The ages of the patients with adenoid basal carcinoma ranged from 30 to 91 years with a mean of 71 years. Pap smear results for 11 of 12 (92%) were abnormal. Almost all patients were asymptomatic. None had a gross cervical tumor. All tumors had typical histologic features of adenoid basal carcinoma, with various degrees of squamous differentiation. Depth of tumor invasion ranged from 2 mm to 10 mm (mean, 4.3 mm; median, 3.7 mm), exceeding 3 mm in six tumors (50%). Tumor volume was >500 mm3 in four tumors (33%). An associated neoplastic squamous lesion was present in 92% of patients, including high-grade cervical intraepithelial neoplasia in 10 cases and microinvasive squamous cell carcinoma in one. Treatment was predominantly surgical, usually after some form of cervical conization; conization alone was performed in three patients. Lymph nodes were removed in five patients; none of 104 nodes had metastases. No recurrence of tumor developed in any patient. Nine patients were alive without disease after 4 to 82 months (mean, 30 months), and three died without disease after 24, 63, and 87 months. The three patients with adenoid basal hyperplasia also were asymptomatic and did not have a gross cervical lesion. Pap smear results for two patients were abnormal. The adenoid basal hyperplasias were incidental, very superficial lesions that resembled small adenoid basal carcinomas. Generally, they were attached to the squamous or endocervical mucosal epithelium; all were less than 0.5 mm in depth. Treatment was hysterectomy in one patient and conization in two. Follow-up was short but uneventful. Our findings, together with those previously reported, indicate (1) adenoid basal carcinoma with typical histologic features is not a malignant neoplasm in that it typically presents in asymptomatic women, usually is discovered after an abnormal Pap smear result due to cervical intraepithelial neoplasia, does not produce a grossly visible lesion, has never metastasized to regional lymph nodes or elsewhere, and has never itself caused death; (2) rare, histologically atypical tumors with distinctly malignant features should not be regarded as adenoid basal carcinoma; and (3) adenoid basal hyperplasia probably is a small adenoid basal carcinoma. We propose the term "adenoid basal epithelioma" to replace adenoid basal carcinoma and adenoid basal hyperplasia, because it better describes the clinicopathologic features of these distinctive lesions and their excellent prognosis and may reduce the likelihood of unnecessarily aggressive treatment.
对12例宫颈腺样基底癌和3例宫颈腺样基底增生进行了分析。腺样基底癌患者年龄在30至91岁之间，平均年龄71岁。12例中有11例（92%）巴氏涂片结果异常。几乎所有患者均无症状。均无肉眼可见的宫颈肿瘤。所有肿瘤均具有腺样基底癌的典型组织学特征，伴有不同程度的鳞状分化。肿瘤浸润深度为2毫米至10毫米（平均4.3毫米；中位数3.7毫米），6例肿瘤（50%）浸润深度超过3毫米。4例肿瘤（33%）体积>500立方毫米。92%的患者存在相关的肿瘤性鳞状病变，其中10例为高级别宫颈上皮内瘤变，1例为微浸润性鳞状细胞癌。治疗主要为手术治疗，通常在某种形式的宫颈锥切术后进行；3例患者仅行锥切术。5例患者进行了淋巴结清扫；104个淋巴结均无转移。所有患者均未出现肿瘤复发。9例患者在4至82个月（平均30个月）后无病存活，3例患者在24、63和87个月后无病死亡。3例腺样基底增生患者也无症状，无肉眼可见的宫颈病变。2例患者巴氏涂片结果异常。腺样基底增生为偶然发现的非常表浅的病变，类似于小的腺样基底癌。一般附着于鳞状或宫颈内膜黏膜上皮；深度均小于0.5毫米。1例患者行子宫切除术，2例患者行锥切术。随访时间短但无异常情况。我们的研究结果与先前报道的结果表明：（1）具有典型组织学特征的腺样基底癌并非恶性肿瘤，因为其通常发生于无症状女性，通常因宫颈上皮内瘤变巴氏涂片结果异常而被发现，不产生肉眼可见的病变，从未转移至区域淋巴结或其他部位，也从未导致死亡；（2）罕见的、具有明显恶性特征的组织学非典型肿瘤不应被视为腺样基底癌；（3）腺样基底增生可能是小的腺样基底癌。我们建议用“腺样基底上皮瘤”一词取代腺样基底癌和腺样基底增生，因为它能更好地描述这些独特病变的临床病理特征及其良好的预后，并可能降低不必要的积极治疗的可能性。
