I. Cervical glandular hyperplasia
1. Tunnel clusters are mostly incidental findings in surgical specimens, sometimes involving the deeper layers of the cervical wall and resembling tumors to the naked eye. They are usually clinically asymptomatic and are more commonly seen in women over 30 years of age who have had multiple births, and in some cases, combined with pregnancy. Histologically, the endocervical glands are ductally dilated, densely packed, similar in size and morphology, with a lobular or clustered distribution of cystic ducts; only a small amount of cervical interstitium is seen between the ducts. Although the ductal expansion is often deeper and sometimes heterogeneous, it retains a lobular distribution and does not infiltrate the interstitium.
2. microglandul hyperplasia (MGH) is seen in the glandular epithelium of the cervical ducts in women of childbearing age. It may be associated with oral contraceptives or pregnancy, but it is also seen in postmenopausal women and may be related to inflammatory stimulation. Histologically, it is characterized by a proliferation of reserve cells of the cervical glands. The glands are hyperplastic in clusters or tufts, with a more uniform size of the hyperplastic glands, smaller glandular lumen, and a short cuboidal epithelium, often with squamification and subnuclear vacuoles. If the cells have focal mild-moderate anisotropy, it is called atypical microglandular hyperplasia and is often accompanied by a marked inflammatory response. MGH with heterogeneity is easily misdiagnosed as adenocarcinoma. The following points can be distinguished from adenocarcinoma: (1) ask about the medical history, and be cautious in diagnosing MGH in postmenopausal women; (2) there are typical microglandular hyperplasia structures; there is no papillary structure; the cell heterogeneity is mild and there is no pathological nuclear division; (3) the hyperplastic glands are confined to the mucosal layer and there is no infiltration; (4) there is no obvious thickening and hardening of the cervix on clinical examination; (5) the cytoplasm contains mucus rather than glycogen, and the immunohistochemistry is CEA negative.
3. mesoneplmc hyperplasia (mesoneplmc hyperplasia) residual mesonephric ducts are small round glandular ducts with cuboidal or dwarf columnar epithelium, without cilia and without mucus or glycogen. The ducts are dilated with PAS-stained positive eosinophilic hyaline material in the lumen. The residual mesonephric ducts are densely clustered or diffusely distributed, and sometimes the hyperplastic ducts form papillae or reticular or lacunar structures, but there is no cellular heterotypy or nuclear division; with atypical hyperplasia, there may be heterotypy and nuclear division, which should be distinguished from mesonephric duct carcinoma. The latter has a naked eye visible mass with denser glandular ducts, more prominent nuclear division and heterotypy, and interstitial infiltration. In the case of cystic mesonephric duct hyperplasia, it should also be differentiated from tubular cystic clear cell carcinoma, in which the cell heterotypy is not prominent, the cytoplasm does not contain glycogen, and there is no solid lamellar or hobnail-like structure as in clear cell carcinoma.
Lobular endocervical glandular hyperplasia (LEGH) is seen in women of childbearing age, some cases are clinically symptomatic and form nodules containing large and small sacs, usually limited to 1/20th of the cervical wall in a lobular structure microscopically. larger gland in the center. The glandular epithelium is highly columnar mucinous epithelium and well differentiated. It differs from minimally deviated adenocarcinoma by the preservation of lobular structure and the absence of infiltrative growth.
Diffuse laminar endocervical glandular hyperplasia is confined to the inner 1/3 of the cervical wall and is laminar in shape, with clear demarcation from the interstitium beneath it. The glands are diffusely distributed and are often accompanied by a marked inflammatory response and reactive hyperplasia of the epithelium.
II. Cervical glandular intraepithelial neoplasia and adenocarcinoma
Theoretically, the process of cervical glandular malignancy is the same as that of squamous epithelium, and the process of cervical glandular intraepithelial neoplasia (CGrN) to invasive carcinoma may also be a continuous process, i.e., from cervical glandular intraepithelial neoplasia (CGIN) to invasive carcinoma. It is often accompanied by squamous epithelial lesions; however, precancerous lesions of cervical adenocarcinoma are far less well established and obstructed than those of squamous carcinoma, and due to the lack of adequate follow-up studies, there are no uniform and clear morphological diagnostic criteria for atypical hyperplasia of the cervical glands. Infiltrative carcinomas can also be classified as microinfiltrative and invasive carcinomas. The definition of microinfiltrating adenocarcinoma is the same as that of squamous carcinoma, but the measurement method is not clear and is now mostly replaced by the thickness of the tumor.
1. adenocarcinoma in situ (AIS) is far less common than squamous carcinoma in situ. Morphologically defined as having malignant cell features but retaining normal glandular location and structure; sometimes there can be small papillae in the glandular lumen. In practice, we should strictly grasp the criteria and not mistakenly misdiagnose early well-differentiated invasive carcinoma as carcinoma in situ. Like squamous carcinoma in situ, biopsy specimens can only be used for the diagnosis of suspected carcinoma in situ, and the diagnosis of carcinoma in situ of cervical gland can only be made through full excision of the uterus or cervical conization specimens and comprehensive examination. The following points can be used as histological diagnostic indicators of cervical glandular carcinoma in situ: (1) the outline of the gland is smooth and confined to the original lobular structure, similar to breast carcinoma in situ; (2) the hyperplastic gland is located in the endothelium and the depth does not exceed the original endothelial thickness; (3) it exists in the same glandular structural unit as the normal glandular epithelium, i.e., in the same basement membrane, and the boundary between the two is distinct without migration; (4) the hyperplastic glandular lobules are enlarged in size and may have (4) the enlarged glandular lobules are enlarged and may have obvious cellular heterogeneity, but generally no sieve-like or surface papillary structures; (5) there is no obvious interstitial reaction (including edema, inflammatory cell infiltration and fibrosis, etc.). The most important of the above points is enlarged lobular hyperplasia with obvious heterogeneity, but without clear interstitial infiltration.
There are four histological types of uterine preglandular carcinoma in situ: cervical glandular, endometrial, intestinal and miscellaneous (e.g. plasmacytosis, clear cell and adenosquamous carcinoma, etc.), the first three being more often associated with squamous intraepithelial tumors. These different histologic types of adenocarcinoma in situ have their own morphologic characteristics, and their clinical significance remains to be further explored.
Microinvasive adenocarcinoma (MIA), also known as early infiltrating adenocarcinoma, is defined in the same way as early infiltrating squamous carcinoma, but there is no consensus on the method of measuring the depth of infiltration due to the structural characteristics of the tubular cervical glands. The morphological indications of infiltration are: (1) single cells or incomplete glandular fragments with definite malignant cell characteristics in the interstitium; (2) malignant glands with surrounding interstitial reaction; (3) small glands with complex branching or fusion of glandular structures; (4) malignant epithelium without interstitium filling the glandular lumen in a sieve-like structure with surrounding interstitial reaction; (5) located deep in the normal gland. In practice about 10-15% of cases are pathologically difficult to specify microinfiltration and can be replaced by the thickness of the tumor. Microinfiltration cannot be diagnosed when the lesion involves the margins of the biopsy tissue or when there is ulcer formation on the surface of the lesion.
It is a clear-cut boundary between the two when it exists within the same basement membrane as the normal glandular epithelium (HE).
3. Invasive adenocarcinoma is rare and accounts for only about 5% of all epithelial malignancies of the cervix. The main clinical symptom is cervical bleeding (>75%).
Gross] It may appear as nodules, polyps or form ulcers, etc. About 15% of cases have no obvious abnormality in the gross, or only have changes such as cervical hypertrophy and slight roughness.
[Light microscopy] The histological types of cervical adenocarcinoma are diverse, and it can present adenocarcinoma of various types of epithelium similar to Mullerian epithelium. Histological typing is mainly mucinous epithelial type, partly endometrioid, clear cell adenocarcinoma or adenosquamous carcinoma, and a few rare special types such as adenoid cystic carcinoma, adenoid basal cell carcinoma and microcystic adenocarcinoma.
Types (lX’HO. 2003) I 18 I
Mucinous adenocarcinoma
Endometrioid adenocarcinoma
Clear ceU adenocarcinoma
Minimal devation adenocarcinoma
Well-differentiatedviUoglanduLar
Adenocarcinoma adenocarcinoma
Serous adenocarcinoma
Mesonephric carcInoma
[Differential diagnosis] The diagnosis of typical cervical adenocarcinoma is not difficult. It is mainly distinguished from adenocarcinoma metastasizing to the official neck and benign lesions of the official cervical glands. Since the tissue types of endometrial and ovarian cancer can be similar to cervical adenocarcinoma, care should be taken to exclude metastatic adenocarcinoma when diagnosing primary adenocarcinoma of the cervix, especially advanced cervical adenocarcinoma. When it is difficult to differentiate histologically from adenocarcinoma metastatic from endometrium or ovary, positive immunohistochemical staining for CEA helps to diagnose cervical adenocarcinoma, while positive ER.PR and Vimentin help to diagnose endometrial cancer; it also depends on observation of large specimens, sampling, detailed medical history and comprehensive clinical examination for differentiation.
Histologically, most cervical cancers are highly and moderately differentiated adenocarcinomas, especially the highly differentiated mucinous adenocarcinoma is easily missed, especially when inflammation is more obvious and easily misdiagnosed as inflammatory hyperplasia. The following characteristics of adenocarcinoma can be used to distinguish between carcinoma and hyperplasia: (1) nodular or irregular hyperplasia, which is beyond the normal structural units, i.e., not confined to the lobules, and the original structure disappears; (2) the size of the glandular cavity varies, and irregular cords or incomplete glandular cavity-like structures with obvious heterogeneity are often seen on close examination, especially in multiple sections; (3) the hyperplastic gland is infiltrated by deeper tissues; (4) although the cells may be monolayered, the nuclei are often enlarged. Although the cells may be monolayered, the nuclei are often enlarged, darkly stained, irregular in shape, with coarse chromatin, etc. Pathological nuclear division is sometimes seen; ⑤ sometimes there may be heterogeneous nuclear upward shift and disorganized polarity; ⑥ there are obvious interstitial reactions such as inflammatory cells, edema and fibrous interstitium. Interstitial reactions are not always present in every field of view, but they can be seen on close examination.
In pregnancy, the cervical epithelium may have obvious Ariatella (A-S) reaction with enlarged nuclei and transparent cytoplasm, but the following points can be distinguished from cervical clear cell adenocarcinoma: (1) the A-S reaction occurs in pregnancy, although the nuclei may be enlarged and deeply stained, there is no nuclear division activity, let alone pathological nuclear division; (2) the glands are more regular, without obvious cystic dilatation or solid striated hyperplasia; (3) there is no cancerous fibrous interstitial reaction; (4) there is no deep interstitial reaction. reaction; ④ no infiltration of deep tissue, etc.