【病理每周一题】No.400（2014.6.23—2014.6.29，答案已公布）

p****y

本周病例（2014.6.23—2014.6.29）

女性，49岁，因宫颈活检示HSIL行宫颈锥切术。

1、你考虑什么诊断？
2、需要做什么鉴别诊断？
3、本病预后如何？

我***医

我是临床的，不懂，不过爱爱医的活动我对支持

x****g

宫颈腺样基底细胞肿瘤合并CIN3

a****n

xhyong 发表于 2014-6-23 20:50
宫颈腺样基底细胞肿瘤合并CIN3

同意！

第四版WHO
Adenoid basal carcinoma

Definition
An epithelial tumour composed of small ,well differentiated, rounded nests of basaloid cells.

ICD-Q code 8098/3

Synonym
Adenoid basal epithelioma

Etiology
In contrast to other carcinomas, it is postulated that ** has its origin From a reserve cell (667,1733). High-risk HPV (types 16, 33) has been identilied in
** .

occurs in elderly (mean age 60 to 71 years, range 30 to 91 years), often blacks

Macroscopy
Usually no gross abnormality unless another subtype of carcinoma is also present

Histopathology
Adenoid basal carcinoma (**) is an epithelial tumour composed solely small ,well-differentiated, rounded nests basaloid cells that have scanty cytoplasm
and which resemble basal cell carcinomas in the skin. The tumour cells form rounded nests or cords which inliltrate the superficial cervical stroma. The nests
of tumour cells may contain cent cystic spaces that are lilled with necrotic debris and there may also be focal glandular or
squamous differentiation in the centre of the nests. The small cells are p16 positive . A definitive diagnosis of ** requires evaluation the entire tumour. ** is olten associated with squamous intraepithelial lesion or another carcinoma subtype .
The presence many invasive carcinoma subtype with ** should be reportedas a 'mixed carcinoma'. 'Adenoid basal hyperplasia' has been described, and may be distinguished from **. Adenoid basal hyperplasia is characterized bya similar proliferation small basaloid
nests extending less than 1 mm Irom the basement membrane . The differential diagnosis ** includes other basaloid
carcinomas, such as adenoid cystic carcinoma (ACC), basaloid squamous cell carcinoma, and neuroendocrine carcinomas . ** and ACC share many immunohistochemical similarities ACC is often CD117 positive, in contrast to adenoid basal carcinoma

Prognosis and predictive factors
Pure ** is a low-grade tumour with an excellent prognosis and rarely metastasizes. Although the alternate term "adenoid basal epithelioma" has been suggested to
reflect this good outcome, ** is an established term and should be retained. The outcome mixed carcino阿las and ** is largely dependent upon prognostic features 01 the non-** component. In view of this altered prognosis a diagnosis of ** should be restricted to cases that consist entirely of **.

Figure 1: nests of basaloid cells with overlying HSIL 2: central squamous differentiation with microcysts, plus nests of small basaloid cells with scant cytoplasm and hyperchromatic nuclei

j****3

学习一下
谢谢

r****x

看了文字介绍，在看切片，支持腺样基底细胞癌的诊断

k****3

XHyong一如既往的厉害！

f****g

完全支持,形态典型

刘*强

宫颈腺上皮鳞化,并CIN3.早期浸润癌待排.

刘*强

宫颈腺上皮鳞化,未成熟型并CIN3.早期浸润癌待排.
主要与上皮内肿瘤及分化性鳞癌鉴别
愈后尚可.

x****g

kint123 发表于 2014-6-25 21:16
XHyong一如既往的厉害！

过奖了，师兄，去年写了一个短篇，就是关于宫颈腺样基底细胞癌的

p****y

本周病例（2014.6.23—2014.6.29）

1、你考虑什么诊断？
腺样基底细胞癌（Adenoid basal carcinoma，**）

**的发病机制尚不清楚，临床症状不明显，与其他恶性宫颈损伤的关系尚不明确，常在诊断其他宫颈疾病时发现，且于HPV感染有一定关联。

2、需要做什么鉴别诊断？
腺鳞癌、CIN III伴累腺、腺样囊性癌等

3、本病预后如何？
单纯的**是一种预后良好的低级别肿瘤，极少发生转移，因此有人认为使用腺样基底样上皮瘤（adenoid basal epithelioma）来反应其预后好这一特性。而对于混合性病例，其预后取决于非**成分。

－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－－

本期病例比较典型，结合临床病史、组织学形态和免疫组化不难诊断。综合回答思路，xhyong、akeman加一分，刘定强累积半分，我不是名医、jinchuanze163、rattlebox、kint123、fusuyong鲜花鼓励！

希望大家一如既往的支持病理每周一题，