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目的:探讨宫颈原位腺癌(adenocarcinoms in situ of the cervical,AIS)伴宫颈高级别上皮内瘤变(CINⅢ)的临床病理组织学特点和鉴别诊断。方法:回顾2例宫颈原位腺癌伴CINⅢ患者的临床与病理组织学特点及免疫组化结果,结合相关文献资料进行分析。结果:临床表现:2例患者均表现为接触性出血,白带检查高危型人类乳头状瘤病毒(hr HPV)阳性。病理组织学:2例病变宫颈黏膜下腺体表现为原位腺癌,伴有CINⅢ。免疫组化:宫颈原位腺癌区域表达CK、CK18、CEA,CINⅢ区域表达CK、34βE12、CK5/6、P63,两区域共同表达P16和Ki-67,不表达VIM、ER、PR。结论:宫颈原位腺癌伴CINⅢ非常罕见,它的发生发展与hr HPV和P16密切相关,发生癌变的细胞可导致激素受体的丢失和增殖指数的升高,两者的相互作用可引起宫颈鳞状上皮和腺上皮同时癌变。免疫组化染色CEA、VIM、ER、PR、P16、Ki-67在其诊断与鉴别诊断方面有重要作用。
Objective: To investigate the clinicopathological features and differential diagnosis of cervical intraepithelial neoplasia (CINⅢ) with adenocarcinoms in situ of the cervical (AIS). Methods: Two cases of cervical adenocarcinoma with CIN Ⅲ clinical and histopathological features and immunohistochemical findings, combined with relevant literature data were analyzed. Results: Clinical manifestations: Both patients presented with contact bleeding, with positive HPV testing for leucorrhea. Histopathology: 2 cases of cervical submucosal lesions showed adenocarcinoma in situ, with CIN Ⅲ. Immunohistochemistry: The expression of CK, CK18, CEA and CINⅢ in the cervical adenocarcinoma of the cervix was expressed in CK, 34βE12, CK5 / 6 and P63, P16 and Ki-67 were co-expressed in both regions, but not in VIM, ER and PR. Conclusion: Adenocarcinoma of the cervix with CIN Ⅲ is very rare. The occurrence and development of cervical adenocarcinoma is closely related to hr HPV and P16. Cancerous cells can lead to the loss of hormone receptor and the increase of proliferation index. The interaction between the two can cause cervical Squamous epithelium and glandular epithelium at the same time cancer. Immunohistochemical staining CEA, VIM, ER, PR, P16, Ki-67 in the diagnosis and differential diagnosis of an important role.