摘要
目的:探讨非人乳头状瘤病毒(human papillomavirus,HPV)相关型宫颈腺癌临床病理学特征、鉴别诊断、分子特征及治疗和预后。方法:回顾性分析9例非HPV相关型宫颈腺癌的临床特征、病理学形态、免疫表型及治疗和预后,并复习相关文献。结果:患者均为女性,年龄18~57岁,平均45岁。4例宫颈透明细胞癌,5例宫颈胃型腺癌。3例宫颈透明细胞癌临床表现为异常子宫出血,1例年轻患者表现为宫颈赘生物。病理组织学特征表现为小管状、微囊型、乳头状或呈实性生长方式,肿瘤细胞内含透亮、富于糖原的细胞质,细胞核大,核仁明显,呈靴钉样外观,可见致密的嗜酸性间质和玻璃样变小体。免疫组化HNF1-β、Napsin-A、PAX8阳性,Ki-67增殖指数较高(60%~80%),ER、PR、p16阴性;3例宫颈胃型腺癌表现为阴道排液,1例因盆腔包块入院检查发现,1例体检发现。影像学对宫颈胃型腺癌具有特征性,2例胃型腺癌磁共振成像(magnetic resonance imaging,MRI)示宫颈囊实性肿块。病理组织学特征表现为肿瘤性黏液腺体不规则浸润性生长,超出正常宫颈内膜腺体的位置,腺体形态不规则、大小不一,经常成角或囊状,有一些伴有腔内乳头,往往腺体紧邻厚壁血管,间质反应一般轻微或无。肿瘤细胞边界较为清晰,胞浆透明至嗜酸性,内含丰富的黏液,细胞核可有异型性,核分裂象较为罕见。宫颈胃型腺癌表达MUC6、CEA,60%病例p53表现为突变型,p16阴性,宫颈胃型腺癌阿利辛蓝-过碘酸雪夫染色(Alcian blue Periodic acid-Schiff,AB-PAS)呈PAS阳性。所有9例患者HPV检测均为阴性。结论:宫颈透明细胞癌和胃型腺癌均为非HPV相关型宫颈腺癌,临床少见,恶性度高,具有一定的组织形态及免疫组化特征,联合运用一组免疫组化标记物有助于该类疾病的诊断。
Objective:To investigate the clinicopathologic characteristics,differential diagnosis,molecular characteristics,treatment and prognosis of human papillomavirus(HPV)-independent cervical adenocarcinoma.Methods:A retrospective analysis was conducted on 9 cases of HPV-independent cervical adenocarcinoma,including clinical features,pathological features,immunophenotype,treatment and prognosis.The relevant literature was reviewed.Results:Patients were all females,aged 18~57 years old,with an average of 45 years old.There were 4 cases of cervical clear cell carcinoma and 5 cases of cervical gastric-type adenocarcinoma.3 patients with cervical clear cell carcinoma were displayed as abnormal uterine bleeding,and one young patient showed cervical vegetations.Microscopic examination showed characteristic features of cervical clear cell carcinoma,including tubular,microcystic,papillary,and solid patterns with clear cytoplasm and hyperchromatic nuclei.The nuclei are large,with prominent nucleoli and a boot-like appearance,with dense eosinophilic stroma and hyaline bodies.The immunohistochemical results was positive for HNF1-β,Napsin-A,and PAX8.The proliferation index of Ki-67 was high(60%~80%),and ER,PR,and p16 were negative.3 patients with gastric-type adenocarcinoma were manifested as vaginal discharge,and one case was found due to pelvic mass admission examination,and one case was found by physical examination.Imaging revealed cervical masses or cysts in gastric-type adenocarcinoma.Gastric-type adenocarcinoma were manifested as irregular invasive growth of neoplastic mucinous glands,beyond the position of normal endocervical glands,irregular glands often angular or sac-like,some accompanied by intraluminal papillae,often closed to thick-walled blood vessels.The desmoplastic reactions were mild or absent.The boundaries of tumor cells were clear.The cytoplasm was transparent to eosinophilic,rich in mucous.The nucleus may have atypia,and the mitotic figures were rare.Cervical gastric-type adenocarcinoma generally expressed
作者
张和平
许宏亮
陈勇
汪勤
赵彩霞
唐曼
张卫琴
ZHANG Heping;XU Hongliang;CHEN Yong;WANG Qin;ZHAO Caixia;TANG Man;ZHANG Weiqin(Department of Pathology,Maternity and Child Health Hospital Affiliated to Anhui Medical University/Anhui Province Maternity and Child Health Hospital,Anhui Hefei 230001,China)
出处
《现代肿瘤医学》
CAS
2024年第4期713-719,共7页
Journal of Modern Oncology
基金
安徽医科大学校科研基金(编号:2020xkj066)。
关键词
非人乳头瘤病毒相关
宫颈腺癌
透明细胞型
胃型
human papillomavirus-independent
cervical adenocarcinoma
clear cell type
gastric-type
