摘要目的 分析宫颈腺上皮肿瘤性病变的临床及病理特征,探讨免疫组织化学在早期宫颈腺癌及癌前病变鉴别诊断中的意义.方法 对80例宫颈高级别腺上皮内瘤变(HCGIN)、20例宫颈浸润性腺癌(ICA)以及20例宫颈炎病例进行临床及病理形态分析,并进行p16、Ki-67、癌胚抗原(CEA)、CA125、bcl-2免疫组织化学EnVision法染色.结果 HCGIN组临床特征与高级别宫颈鳞状上皮内瘤变(CIN)相似,同时伴CIN者44例(55.0％),伴早期鳞状细胞癌9例(11.3％).病理形态以原位腺体异形改变为特征.80例HCGIN中p16、CEA、Ki-67的阳性表达比例分别为100.0％、63.8％、73.8％；20例ICA中p16、CEA、Ki-67的阳性表达比例分别为18/20、16/20、20/20；20例宫颈炎中p16、CEA、Ki-67的阳性表达比例分别为1/20、1/20、3/20；p16、CEA、Ki-67在ICA和HCGIN组的表达较宫颈炎组均显著升高(P ＜0.01)；Ki-67在ICA组的表达增高,与HCGIN组相比差异有统计学意义(P ＜0.05)；CEA在ICA组的表达与HCGIN组相比差异无统计学意义(P＞0.05).CA125非特异性反应强,bcl-2各组腺体阴性或偶有阳性.结论 HCGIN易与CIN和鳞状细胞癌伴发,p16、CEA、Ki-67联合检测有助于早期宫颈腺癌及癌前病变的诊断,p16和Ki-67对HCGIN的敏感性高于CEA,CA125和bcl-2对HCGIN的鉴别诊断意义不大.

abstractsObjective To assess the clinicopathologic characteristics of cervical glandular intraepithelial neoplasia (CGIN) and to evaluate the usefulness of EnVision immunohistochemistry of various markers in identifying early invasive cervical adenocarcinoma (ICA) and its precursor lesions.Methods Clinical and pathological characteristics of 80 cases of high grade CGIN (HCGIN),20 ICA,and 20 cervicitis were reviewed along with immunohistochemical studies of p16,Ki-67,CEA,CA125 and bcl-2.Results The clinical features of HCGIN were similar to those of high grade cervical intraepithelial neoplasia (CIN).Fourty four cases (55.0％) accompanied with CIN and 9 cases (11.3％) accompanied with early cervical squamous cell carcinoma (SCC).The positive rates of p16,CEA and Ki-67 in 80 cases of HCGIN were 100.0％,63.8％ and 73.8％,respectively.The positive rates of p16,CEA and Ki-67 in 20 ICA were 18/20,16/20 and 20/20,respectively.The positive rates of p16,CEA and Ki-67 in 20 cervicitis were 1/20,1/20 and 3/20,respectively.There was a significantly increased expression of p16,CEA and Ki-67in ICA and HCGIN compared with cervicitis (P ＜ 0.01).Ki-67 expression increased in ICA compared to HCGIN (P ＜ 0.05).There was no statistical difference in CEA expression between ICA and HCGIN (P ＞0.05).CA125 showed strong but nonspecific expression.Bcl-2 was negative or occasionally positive in each groups.Conclusions HCGIN is frequently accompanied with CIN and SCC.The combined staining of p16,CEA and Ki-67 provides additional aid in the diagnosis of early stage cervical adenocarcinoma and its precursor lesions.The sensitivity of p16 and Ki-67 markers for HCGIN is higher than that of CEA.CA125and bcl-2 immunostains offer no helpful in identifying HCGIN.