子宮頚部円錐切除術により治癒したじゅう毛腺管状乳頭腺癌の１例 A case of villoglandular papillary adenocarcinoma of the uterine cervix treated by conization alone.

<B>背景:</B>子宮頸部絨毛腺管状乳頭腺癌はYoungとScullyにより1989年に提唱された腫瘍で, 現在まで約50例程度の報告があるまれな腫瘍である.予後良好とされているが治療として子宮全摘術が施されていることがほとんどである.今回われわれは子宮頸部円錐切除術のみで長期寛解をえた貴重な症例を経験したので報告する.<BR><B>症例:</B>38歳, 女性, 0妊0産.不正性器出血, 帯下増量を主訴に来院.子宮頸部には外向性に広がる易出血性の腫瘍を認めた.子宮頸部擦過細胞診では出血性背景に比較的小型で類円形のクロマチン増量した核をもつ乳頭状の細胞集塊を多数認めた.構造異型が著明であった.平成9年8月, 子宮頸部円錐切除術を施行.病理組織診断にて絨毛腺管状乳頭腺癌であり, 筋層浸潤は圧排性でごく軽度, 脈管浸潤は認めなかった.切除断端に癌細胞を認めなかった.本人が強く妊孕性温存を希望したため治療を終了し現在まで62ヵ月再発を認めていない.<BR><B>結論:</B>円錐切除のみで治癒した絨毛腺管状乳頭腺癌の1例を報告した.細胞診では核クロマチンが増量した乳頭状の細胞集塊の出現が特徴である.

<B><I>Background</I>:</B> Villograndular papillary adenocarcinoma (VPA) of the uterine cervix was first described by Young and Scully in 1989. About 50 cases have been reported thus far. Despite its excellent prognosis, hysterectomy has been done in almost all cases. We report a case of VPA, treated by conization alone, resulting in long remission.<BR><B><I>Case</I>:</B> A 38-year-old Japanese woman reporting abnormal vaginal bleeding and increased discharge was found to have the cervix invaded by a papillary tumor. Cytological findings showed many papillary clusters with mild nuclear hypercromatism. Conization was done in August 1997. The tumor showed exophitic growth with superficial myometrial invasion, and was diagnosed as VPA. No cancer cells were seen in the surgical margin. The patient wished to have children, so no hysterectomy was done. She survives without recurrence at 5years and months as of this writing.<BR><B><I>Conclusion</I>:</B> We reported a case of VPA treated by conization. The most important cytological features in VPA diagnosis are papillary clusters with nuclear hypercromatism.