【摘要】 目的 分析子宫颈人乳头瘤病毒（HPV）相关性原位腺癌（adenocarcinoma in situ, AIS）的临床病理学特征，探讨形态差异与病变进展的关联性及其临床意义。方法 收集2016年1月至2021年9月绍兴市妇幼保健院接受子宫颈锥切术和（或）单纯子宫切除术诊断为AIS的患者51例，根据WHO(2014)女性生殖系统肿瘤分类，将细胞异型轻微、核分裂或凋亡小体略增多者，归为形态不完整AIS；比较不同形态下的宫颈细胞学（TCT）、HPV、发病年龄、病变范围、治疗方案及随访结果的差异。结果 51例患者包括23例形态不完整AIS、21例形态完整AIS、7例Silva A型腺癌，三者病变厚度和宽度比较，差异均有统计学意义（P <0.05）；形态完整AIS与Silva A型腺癌宫颈锥切后病变残留率显著高于形态不完整者（P <0.05）。结论 HPV相关性子宫颈腺性病变在发展为浸润性腺癌前，可能经历形态不完整AIS、形态完整AIS、Silva A型腺癌的病变递进过程。形态不完整AIS适合保守治疗；无生育要求的形态完整AIS与Silva A型腺癌，建议全子宫切除，但子宫颈锥切切缘阴性仍提示预后良好，可制定个体化方案，避免过度治疗。更多还原

【Abstract】 Objective To analyze the clinicopathological features of cervical HPV-associated adenocarcinoma in situ(AIS) and to explore the correlation and clinical significance between morphological differences and lesion progression. Methods 51 cases of AIS diagnosed by cervical conization or simple hysterectomy in Shaoxing Women and Children Health Hospital from January 2016 to September 2021 were collected. According to the WHO(2014)classification of tumours of female genital tumours, those with minimal nuclear atypia and slightly increased mitoses or apoptotic bodies were supported as morphologically incomplete AIS. TCT, HPV, age of onset, extent of lesion, treatment plan and follow-up results were compared in patients with different morphology. Results The 51 patients included 23cases of AIS with morphologically incomplete, 21 cases of AIS with morphologically complete, and 7 cases of Silva A-type adenocarcinoma; There were significant differences in thickness and width between AIS with morphologically incomplete, AIS with morphologically complete and Silva A adenocarcinoma(P < 0.05); The residual rates of AIS with morphologically complete and Silva A-type adenocarcinoma were higher than AIS with morphologically incomplete(P < 0.05). Conclusions HPV-related glandular lesions of the cervix may progress through incomplete morphological AIS, complete morphological AIS, and Silva A-type adenocarcinoma before developing into invasive adenocarcinoma.Incomplete morphological AIS is suitable for conservative treatment. For complete morphological AIS and Silva A-type adenocarcinoma without fertility requirements, total hysterectomy is recommended. However, if the conization margins are negative, it indicates a good prognosis, and individualized treatment plans can be formulated to avoid overtreatment.更多还原