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양성병변으로 오진하기 쉬운 자궁경부의 Adenoma Malignum : 6예에 대한 임상병리학적 분석 A Clinicopathological Analysis of six cases
김태진,심재욱,임경택,백희수,박종택,김희숙 대한부인종양 콜포스코피학회 1994 Journal of Gynecologic Oncology Vol.5 No.1
Six cases of a rare variant of endocervieal adenocarcinoma (Adenoma maligum, AM) were collected for clinicopethologic analysis. The everage age of six patients was 49.3 years, and their chief com plaints were persis(ent mucid or watery discharge and intermittent vaginal spotting, The clinical im presaion was carcioma of The uterine cervix in faur out, of six cases. All except one were pathologically confirmed by initia1 biupey. two cases by colposcopic biopsies, two by cone biopsies, one by cone biopsy after suggested AM in calposcopic hiopsy. One case was incidentally found from hysterectnmised speeimen, whi.ch waas suspected as adennmyosis. On gross examination, the cervix usualty appeared either firm or indurated with thickening af the wall excepl one which was presented es a fungnting mass. The characteristic histologic feetures were ext,ensive arborizing endeervical glands with marked variation in size and shape, and the glands lined by mucin conyaining columnar epithelial cells with basal bland looking nuclei but with occasional cytologic atypia and rare mitose. The nenplasi.ic glands were characterized by deep stronml invasion be yond normal enddcervical glands, assosiated with loose edematous periglandular desmaplastic stromal reaction in moat cases. Immunohistochemical stainnings for carcinoembryonie antigen (CEA) revealed ey- toplasmic positivity in five cases. The clinical stage for all exeept one incidental case were : four Ib and one II b. In three cases, the radical hysterectomy with unilateral salpingooophrectomy plus dissection of bipateral pelvic and paraaortic lymph nodes was performed, and in one case rationtherapy was done prior to radical hysterectomy with bilateral salpingooophorectomy plus the dissection of left pelvic lymph modes followed by chemotherapy. Total abdominal hysterectomy with bilateral salpingooophorectomy plus Burch's operation follwed by radiation therapy was performed in on case. the remaining one case was treated with radiation therapy. Metastasis to the left ouburator lymph node was discovered in one case with stage IIb, and the patient expired 29 monthes after the radiotherapy. The remaining five cases are being carefully followed up. From our experience, we conclude that the early disgnosis of AM can be made based on comprehensive analysis concerning the clinical features., histopathlogical and immunohistochemical findings. The early diagnosis and proper therapy can lead to the better prognosis