Hirai Y, Takeshima N, Haga A, Arai Y, Akiyama F, Hasumi K
Departments of Gynecology and Cytology, Department of Pathology, Cancer Institute Hospital, Cancer Institute, 1-37-1,Kami-Ikebukuro, Toshimaku, Tokyo, 170, Japan.
Gynecol Oncol. 1998 Aug;70(2):219-23. doi: 10.1006/gyno.1998.5092.
To investigate the nature and the clinical course of adenoma malignum (the so-called minimal deviation adenocarcinoma) of the uterine cervix by conducting a retrospective study of 6 cases consecutively treated in a single institute.
The pathologic classification of adenoma malignum was performed according to the WHO classification (1994).
These tumors accounted for only 1.32% (6/453) of invasive cervical adenocarcinomas. All the cases showed either a watery discharge or atypical genital bleeding, or both, at the time of diagnosis. The preoperative cytologic diagnosis of adenoma malignum was made in 83.3% (5/6) of cases. The preoperative punch biopsy, on the other hand, failed to confirm the diagnosis of adenoma malignum in all cases, although the presence of the disease was suspected in 2 cases (33%). The 5-year survival rate and 5-year disease-free survival rate were 100 and 83.3%, respectively.
This series demonstrates that cytologic examination is a potent screening method to detect this rare disease. When the presence of this disease is suspected by the cytologic examination, a deep biopsy is necessary to make an accurate diagnosis. An ordinary cervical biopsy is usually insufficient to detect deeply positioned tumor glands. The prognosis of the disease may be better than that for ordinary cervical adenocarcinoma.
通过对一家机构连续治疗的6例病例进行回顾性研究，探讨子宫颈恶性腺瘤（所谓的微小偏离腺癌）的性质和临床病程。
根据世界卫生组织（1994年）的分类标准对恶性腺瘤进行病理分类。
这些肿瘤仅占浸润性宫颈腺癌的1.32%（6/453）。所有病例在诊断时均表现为水样分泌物或非典型生殖器出血，或两者兼有。83.3%（5/6）的病例术前细胞学诊断为恶性腺瘤。另一方面，术前穿刺活检在所有病例中均未能确诊恶性腺瘤，尽管2例（33%）怀疑患有该病。5年生存率和5年无病生存率分别为100%和83.3%。
本系列研究表明，细胞学检查是检测这种罕见疾病的有效筛查方法。当通过细胞学检查怀疑患有该病时，需要进行深度活检以做出准确诊断。普通宫颈活检通常不足以检测到深部定位的肿瘤腺体。该病的预后可能优于普通宫颈腺癌。
