作　　者： ; ; ; ; ;

机构地区： 深圳市中医院

出　　处： 《临床与实验病理学杂志》 2018年第9期988-992,共5页

摘　　要： 目的探讨子宫颈产黏液的复层上皮内病变(stratified mucin-producing intraepithelial lesion,SMILE)的临床病理特征、诊断及鉴别诊断。方法对4例SMILE进行回顾性分析,观察其组织学特征、免疫表型及超微结构特点,并进行相关文献复习。结果 4例SMILE均为女性,年龄32～49岁。病变组织在镜下均见异型增生的复层上皮细胞,核深染;可见明显的黏液细胞,胞质空泡状;核分裂象及凋亡小体常见。其中3例伴子宫颈高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)或子宫颈原位腺癌(adenocarcinoma in situ,AIS),1例为单纯性SMILE。免疫表型:4例肿瘤细胞p16胞核与胞质阳性,CAM5. 2胞质弥漫阳性,2例IMP3阴性、2例IMP3阳性,4例p63、p40均为部分肿瘤巢基底部上皮细胞表达,Ki-67增殖指数20%～60%。2例获得细胞学随访,均未见复发;2例失访。结论 SMILE不同于HSIL或AIS,有其独立的病理组织学特征,需与子宫颈鳞状上皮内病变、腺上皮病变及未成熟鳞状化生等鉴别。 To investigate the clinicopathologic features,diagnosis and differential diagnosis of stratified mucin-producing intraepithelial lesion(SMILE)of the cervix.Methods 4 cases of SMILE were retrospectively analysed,and the histopathological,immunohistochemical and ultrastructural features were evaluated,combinded with literature review.Results 4 cases were female and the age ranged from 32 to 49 years.On microscopic observation,stratified mucin-producing intraepithelial lesion showed an intraepithelial proliferation of stratified,immature epithelium with round to ovoid,hyperchromatic nuclei.The mucinous cells were present throughout the epithelial layers,and contained mucin in the form of discrete vacuoles,Mitotic figures and apoptotic debris were common in all cases.3 cases showed SMILE and high-grade squamous intraepithelial lesion(HSIL)or adenocarcinoma in situ(AIS)coexisted,1 case was a pure SMILE.Immunohistochemically,p16 demonstrated strong and diffuse expression in 4 cases of SMILE,2 cases SMILE were negative for IMP3 and 2 cases were positive.p63 and p40 was focally positive with limited to the basilar zone in SMILE.CAM5.2 showed diffuse expression.Ki-67 proliferation index was 20%-60%.Follow-up information was available in 2 cases with normal cytology.2 cases lost follow-up.Conclusion SMILE is regarded as an intraepithelial lesion distinct from HSIL and AIS,occurring in cervix,and it has special histopathological features.There are some diagnostic pitfalls,so it should be differentied from HSIL,AIS and immature squamous epithelium metaplasia.

关 键 词： 子宫颈肿瘤 产黏液的复层上皮内病变 诊断 鉴别诊断

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