| Objective: Cervical cancer is one of the most common gynecologic malignancies.With the extensive development of cervical screening,the incidence rate of squamous cell carcinoma of the cervix(SCC)has declined.The clinical manifestations of early non-squamous cell carcinoma of the cervix is relatively atypical,also because of it grows in the hidden location,and the false negative rate of cervical adenocarcinoma cytology screening is high,not easy to be found in the stage of precancerous lesions.The incidence of the disease has increased,especially among young females.In this study,through the analysis of clinical cases of non-squamous cells carcinoma of the cervix(NSCC),discuss its clinical characteristics,the rate of ovarian metastasis,diagnosis,treatment and prognosis of NSCC.Provide guidance for the clinical treatment.Methods: A total of 35 cases of primary NSCC and 228 cases of primary SCC,diagnosed and treated during 2001-01 to 2016-05 in the Army General Hospital.Clinical and pathological data were reviewed and analyzed.Results: 1.The NSCC patients accounted for 13.3% of the same period of cervical cancer.The age of the 35 cases of the NSCC range from 25 to 76,and the average age is50.7±13.3 years old.18 cases(51.4%)are premenopausal patients and 17 cases(48.6%)are postmenopausal patients.Among 35 cases,there are 12 cases of adenocarcinoma of the uterine cervix(34.3%),9 cases of mucinous adenocarcinoma(25.7%),6 cases of adenosquamous carcinoma(17.1%),6 cases of neuroendocrine carcinoma(17.1%),1 case of carcinoma sarcomatodes(2.9%)and 1 case of adenosarcoma(2.9%).The histopathological types of the premenopausal group and the postmenopausal group have significant statistical differences(P<0.05).2.The main symptom of NSCC is abnormal vaginal bleeding accounting for57.1%(20 cases),abnormal vaginal discharge 5.7%(2 cases).The patients who complain both symptom mentioned above account for 28.6%(10 cases),no obvious symptom for8.6%(3 cases).Cervical local manifestations:the surface of cervical exophytic tumors,polypoid or cauliflower in 21 cases,6 cases of ulcer type,8 cases of smooth surface.NSCC group with vaginal discharge was the main symptom of the proportion of cases(34.3%)was significantly higher than that in SCC group(18.9%),NSCC group without visible lesions(22.9%)was significantly higher than that in SCC group(9.3%),there was significant difference between two groups(P>0.05).3.Cervical cytology test of NSCC group: 20 cases had detected the cervical cytology before treatment,in which 12 cases(60%)were abnormal cytology and normal in 8 cases.15 cases were detected HPV.There were positive in 7 cases(47%),all of which were HPV high risk subtype infection.5 cases were HPV16 or(and)18 infection.4.There were 7 cases in the NSCC had reserved ovaries and in the same stage there were 18 cases treated with surgical resection of bilateral ovaries.The five year survival rate of the patients in the reservation group and the non-reserved group were 66.7% and67.3%,compared the two groups of survival rate,there was no significant difference(P > 0.05).5.The 5 years overall survival rate of the NSCC group was 66.1%,and the SCC group was 85.4%.According to Kaplan-Meier method drawing the survival curve,tested by Log-rank method.NSCC group total survival time is shorter than SCC group,difference was statistically significant(P = 0.003).Conclusion: 1.The histopathological types of the premenopausal group and the postmenopausal group have significant statistical differences.It is suggested that some pathological types of NSCC may be related to age and hormone levels.2.The positive rate of the abnormal cervical cytology screening cervical glands is lower than that of the squamous cell carcinoma of the cervix.The clinical characteristics of NSCC determines the existence of a certain rate of missed diagnosis and misdiagnosis,we should pay important attention to its early diagnosis.For TCT,HPVnegative but the patients have clinical symptoms,should do the gynaecology examination on time.if discover the cervical canal enlargement or hard texture,should have cervical curettage or cervical tissue biopsy or diagnostic conization at the same time.3.In the NSCC patients who did not have risk factors,keep ovarian did not increase mortality.Therefore,we believe that young patients with early NSCC,the preservation of the ovary is relatively safe,and can reduce the long-term side effects of castration.4.The prognosis of NSCC is worse than that of SCC,FIGO stage,local large lesions,lymph node metastasis and deep stromal infiltration are the factors affecting the prognosis. |
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