cervical adenocarcinoma
Introduction
Introduction to cervical adenocarcinoma Cervical adenocarcinoma comes from the cervical canal and infiltrates the cervical canal wall. Cervical adenocarcinoma is rarer than squamous cell carcinoma. It has been reported that cervical adenocarcinoma accounts for 15% to 20% of cervical squamous cell carcinoma. Cervical adenocarcinoma can occur in women between the ages of 18 and 84. The average age of onset is around 49 years old, mostly in menopausal women. 1. Cervical intraepithelial neoplasia (CIN): is a precancerous lesion of cervical squamous cell carcinoma, but for cervical adenocarcinoma, there is still debate about the presence or absence of precancerous lesions. Because there is no known abnormal development of intrauterine gland, although pathologists have noticed cases of adenocarcinoma and atypical glands coexisting, it has not been confirmed that this atypical gland will develop into adenocarcinoma. Although there is a slight increase in mild dysplasia from the cervical glandular epithelial cells to moderate to severe dysplasia, and finally developed into a cervical endometrial glandular carcinoma in situ, called cervical intraepithelial neoplasia (CIGN), but Rarely applied in practice. 2. Cervical microinvasive adenocarcinoma (microinvasiveadenocarcinoma): refers to the early infiltration period of cervical adenocarcinoma. As a disease existing between cervical adenocarcinoma and true invasive carcinoma, its definition and morphological criteria have not been unified. Because the normal gland of the cervical canal can extend to the stroma, it is difficult to measure the depth of penetration of this disease, so some scholars advocate the use of early cervical adenocarcinoma (earlycervicaladenocarcinoma) terminology. 3. Cervical invasive adenocarcinoma: When the tumor infiltrating stroma exceeds the standard of microinvasive adenocarcinoma, it is cervical invasive adenocarcinoma. Clinically, most of the cervical adenocarcinoma grows into the cervical canal, which is difficult to detect early, but it has certain difficulties in the diagnosis of precancerous lesions and microinvasive adenocarcinoma. Therefore, precancerous lesions and microinvasive adenocarcinoma are often regarded as cervical invasive glands. cancer. For more than 20 years, the majority of pathologists have a great interest in the diagnosis and classification of cervical adenocarcinoma. The controversy about cervical glandular lesions is mainly concentrated in the following six aspects: 1 understanding and classification of invasive adenocarcinoma; Characteristics of invasive and pre-invasive carcinoma; 3 definition and importance of microinvasive adenocarcinoma; 4 epidemiology and pathology of adenocarcinoma; 5 common subtypes and biological behavior of invasive adenocarcinoma; 6 pairs of similar adenocarcinoma Understanding of benign lesions. basic knowledge The proportion of illness: 0.002% - 0.003% Susceptible people: more occur in menopausal women Mode of infection: non-infectious Complications: breast cancer vulvar Paget's disease rectal cancer
Cause
Causes of cervical adenocarcinoma
Virus infection (40%):
Biological studies have shown that the occurrence of cervical cancer is closely related to human papillomavirus (HPV) infection. HPV DNA can be detected in cervical squamous cell carcinoma and adenocarcinoma tissues. HPV associated with cervical cancer is type 16, 18 and 31. Mainly, but the proportion of HPV in cervical squamous cell carcinoma and adenocarcinoma is different. HPV16 is the main type of cervical squamous cell carcinoma, HPV18 only accounts for 5% to 17% of HPV-positive tumors, but in cervical adenocarcinoma HPV18 dominates, accounting for 34% to 50%, suggesting that HPV 16,18, especially HPV18 may play an important role in the pathogenesis of cervical adenocarcinoma.
Endocrine disorders (40%):
Some scholars believe that the pathogenesis of cervical adenocarcinoma is different from cervical squamous cell carcinoma. It is believed that the occurrence of adenocarcinoma has little to do with sexual life and childbirth, but may be related to endocrine disorders and taking exogenous hormones. Cervical adenocarcinoma occurs mostly in menopause. In this period, hormones are often associated with disorders. Microg-landular hyperplasis can be seen in the cervix of progestogens and pregnant women. This is due to progesterone stimulation of cervical endometrial columnar cell reserve. Cell proliferation and differentiation into the gland, indicating that glandular hyperplasia is related to progesterone. Qizilbash, Gallup et al believe that if the high-dose progesterone preparation is given for 10 or more years, the risk of cervical cancer increases, Gallup reports 35 cases of cervix. Twenty-eight cases of adenocarcinoma have received sex hormone preparations, and 3 of them have been treated with estrogen and progesterone.
Other (10%):
Some related symptoms of cervical adenocarcinoma are considered to have similar characteristics to cervical squamous cell carcinoma, such as early sexual intercourse, sexual life disorder, multiple sexual partners, and similar characteristics with endometrial cancer, infertility, less pregnancy, obesity, hypertension The rate of diabetes is significantly higher than that of cervical squamous cell carcinoma. Some scholars have also noticed the relationship between cervical adenocarcinoma and long-term use of contraceptives. Ireland reported that 8 of 73 patients with cervical adenocarcinoma had taken birth control pills, and Gallup reported 35 cases of cervical cancer. Five of the patients with adenocarcinoma have taken birth control pills for 1 to 8 years. Because the number of cases in most materials is small, the causal relationship between contraceptives and cervical adenocarcinoma is difficult to determine, but it deserves attention.
Prevention
Cervical adenocarcinoma prevention
Early diagnosis, early treatment and follow-up work. If you have the following symptoms, you need to pay attention:
1. Vaginal bleeding: young patients often complain of contact bleeding, after sex or after gynecological examination;
2. Increased leucorrhea: leucorrhea is white, yellowish, bloody or pus and bloody, thin like watery or rice bran water, stinking.
Complication
Cervical adenocarcinoma complications Complications Breast cancer vulvar Paget's disease rectal cancer
Cervical adenocarcinoma can coexist with breast cancer, vulvar carcinoma in situ, vulvar Paget's disease, rectal cancer, etc., the incidence rate is about 1.8%; patients with cervical adenocarcinoma often have CIN, the formation factors of these two cases are not clear, some people think The two lesions are derived from the same precursor - reserve cells. Mair reported that 99 of the 230 cases of cervical adenocarcinoma were associated with CIN, accounting for 43%, of which 23 were mild, 21 were moderate, and 22 were severe. Cervical carcinoma in situ 33 For example, there are 6 cases of invasive squamous cell carcinoma, and Shingleton reported that 1/3 of the patients have malignant squamous cell components. Teshima reported that 10 of 30 early cervical adenocarcinomas coexist with cervical squamous cell carcinoma, Shanghai Medical University. Materials from the maternity hospital reported that 10 of 109 cervical adenocarcinomas had cervical squamous cell carcinoma, accounting for 9%, and the other 4 had invasive squamous cell carcinoma.
Symptom
Cervical gland cancer symptoms Common symptoms Squamous cell metaplasia Cervical erosion vaginal discharge increased anal bulge vaginal discharge increased menopause cavity formation
1. Cervical in situ adenocarcinoma of precancerous lesions: often lack of special clinical manifestations, asymptomatic or cervicitis, confirmed by histopathological examination.
2. Clinical manifestations of microinvasive adenocarcinoma: 15% to 20% of patients with cervical microinvasive adenocarcinoma are asymptomatic, with symptoms mainly characterized by increased vaginal discharge, sometimes watery or mucous, followed by abnormal vaginal bleeding. Often for sexual intercourse bleeding, the cervix can be smashed to varying degrees, or polypoid, papillary, about 1/3 of patients with normal appearance of the cervix.
3. Clinical manifestations of cervical invasive adenocarcinoma: its clinical manifestations are similar to cervical squamous cell carcinoma, early can be asymptomatic, through abnormal cytology smear, the literature reports that 15% to 20% of cervical adenocarcinoma is asymptomatic, Shanghai Medical University women The hospital reported that 13 cases of 109 cases of cervical adenocarcinoma were asymptomatic, accounting for 11.9%. Gallu reported that 3 of 35 cases were asymptomatic, accounting for 8.6%. Among the symptomatic patients, mainly abnormal vaginal bleeding and vaginal discharge, advanced patients According to the extent of the lesion and the invading organs, a series of secondary symptoms such as pain, anal bulge, anemia, urinary system symptoms, etc., utledge reported 219 cases of cervical adenocarcinoma, common symptoms are as follows: 159 cases of abnormal vaginal bleeding, Accounted for 72.6%; vaginal discharge in 28 cases, accounting for 12.8%; pain in 11 cases, accounting for 6.9%; other 6 cases, accounting for 2.7%; asymptomatic 15 cases, accounting for 6.9%. Among them, abnormal vaginal bleeding including sexual intercourse bleeding, vaginal blood, irregular vaginal bleeding or vaginal bleeding after menopause, leucorrhea increased often characterized, watery or mucinous, especially cervical mucinous adenocarcinoma, patients often complained of a large number Mucous leucorrhea, a small amount of purulent yellow water, because of the need to use a perineal pad.
The cervix can be smooth or cervical erosion, polypoid growth, and even cauliflower-like. In advanced cases, the surface of the cervical sac can be ulcerated or cavity formed, covered by necrotic tissue, with vaginal or parametrial infiltration, about one-third of patients The appearance of the cervix is normal, the tumor is often located in the neck tube, but the surface is smooth, the vaginal foramen atrophy in the postmenopausal patients, the cervical atrophy, can make the lesions not obvious.
Examine
Cervical adenocarcinoma examination
1. Exfoliative cytology: Adenocarcinoma can be considered when multiple round, flaky or single polymorphic gland cells are seen in smear specimens of cervical exfoliated cells. Most of the adenocarcinomas have obvious nucleoli, but about half of them The patient's cytology smear can be found without abnormalities.
Cervical exfoliative cytology is used to detect cervical adenocarcinoma, but its positive rate is significantly lower than that of cervical squamous cell carcinoma, only 30%, the false negative rate is high, so it is prone to misdiagnosis and missed diagnosis, may be related to the following factors:
(1) Cervical adenocarcinoma is mostly located in the cervical canal covered columnar epithelium and interstitial gland, and the lesion is concealed, often resulting in insufficient material.
(2) Cervical adenocarcinoma, especially in early adenocarcinoma, is not as prominent as squamous cell carcinoma, especially in highly differentiated mucinous adenocarcinoma.
Atypical glandular cells found in smear should be taken seriously. Kafer1e believes that atypical glandular cell of undetermined significance (AGUS) is not common, but it is an important cytological diagnosis. For the atypical cells with undetermined Bethesda system, the incidence rate in the total cervical smear is 0.18%-0.74%, which is more likely to be associated with clinical lesions. Therefore, repeated cervical cytology may be performed on AGus women. Not enough, it is recommended to do a colposcopy. If the clinical symptoms are highly suspected of cervical adenocarcinoma and the cytology test is negative, further examination is required.
2. Iodine test: The iodine test is non-specific for cancer. The normal cervical epithelium is rich in glycogen, which will be dyed brownish black by iodine, while the cancer epithelium is deficient in glycogen, iodine is not colored, and living tissue is not stained. Improve diagnostic accuracy.
3. Colposcopy: Colposcopy of the cervical adenocarcinoma includes highly differentiated glands. There are scattered or dense columnar villi and honeycomb images around the normal ciliary structure. The colposcopy images of adenocarcinoma are different. In squamous cell carcinoma, due to the special growth of tumor tissue, the central cardiovascular origin of the cervical columnar epithelium is highly enlarged, and the end terminates in the villus-like carcinoma tissue resembling the normal columnar epithelium, forming large and scattered spotted blood vessels, sometimes It can be a hairpin-shaped blood vessel, the blood vessels are thick and abnormally distributed, the surface of the cervix is abnormally enlarged and/or irregularly distributed, the gland is white, and the size is irregular, making the surface of the cervix resemble a honeycomb image, especially for mucinous adenocarcinoma. Therefore, a multi-point biopsy of suspicious sites under the colposcopy should be performed for histopathological examination.
4. Cervical canal scraping: If the lesion is located in the neck tube, neck tube scraping should be performed at the same time as colposcopy, which can significantly improve the correct rate of diagnosis.
5. Cervical cone: Although the cervical biopsy can be clearly diagnosed, it is sometimes impossible to confirm the depth of infiltration due to the limited tissue taken from the biopsy. Therefore, it is necessary to diagnose whether it belongs to stage Ia at least for cervical resection.
6. Cervical and cervical biopsy: the most reliable and indispensable method for the diagnosis of lesions.
Diagnosis
Diagnosis and diagnosis of cervical adenocarcinoma
diagnosis
In addition to medical history, symptoms and signs, the diagnosis of cervical adenocarcinoma is mainly diagnosed by laboratory and auxiliary examinations and by histopathological examination. Because the surface of the cervix is smooth or only mildly erosive, it is the main cause of missed diagnosis of cervical adenocarcinoma.
1. Diagnostic criteria for primary cervical adenocarcinoma: proposed by Maier and Norris: 1 there is a single malignant transition zone; 2 in the diagnosis of scraping or hysterectomy, the endometrium has no malignant features; 3 occurs in the stump of the cervix The cancer was resected in the uterus for more than 5 years; 4 the tumor was located in the cervix, the uterus was normal, and there were no obvious lesions in the uterine cavity.
2. The diagnostic criteria for microinvasive adenocarcinoma are not uniform. Some scholars have proposed diagnostic criteria:
(1) Atypical cell hyperplasia, with normal neck gland structure and glandular hyperplasia, showing fine bud-like or reticular or reticular infiltration, but its depth is less than 1mm.
(2) Atypical cells larger than normal cervical columnar epithelial cells.
(3) Deep nuclear staining, increased proportion of nucleoplasm, see mitotic figures.
3. Early invasive adenocarcinoma of the cervix: Ostor et al. advocated that the early invasive adenocarcinoma of the cervix should be defined as invasive interstitial no more than 5 mm. Other scholars suggested that the invasive interstitial depth should not exceed 2 mm, and the horizontal spread should not exceed 7 mm as microinvasive adenocarcinoma. The boundaries, domestic Chen Zhongnian, Du Xingu, etc. also advocated that the depth of infiltration is less than 2mm as the diagnostic criteria, and some scholars proposed that the tumor volume is less than 500mm3, which is considered to be more predictive of prognosis than the depth of tumor invasion, and less than 500mm3 The rate is very small.
Differential diagnosis
Identification with endometrial cancer: Cervical adenocarcinoma can be primary or metastatic, with the exception of endometrial cancer that extends to the cervical canal.
