子宫内膜小细胞癌二例临床病理及免疫组织化学研究

Primary small cell carcinoma of endometrium: report of two cases with clinicopathological and immunohistochemical study

目的报道2例子宫内膜小细胞癌,讨论其临床病理及免疫组织化学特点。方法2例子宫内膜小细胞癌患者均行广泛全子宫+双侧附件切除+盆腔淋巴结清扫术。病理标本行光镜检查及免疫组织化学分析。结果光镜检查见片、索、巢状分布的小型至中间型肿瘤细胞,胞浆少,核深染、核分裂相多见,可见单个或带状细胞坏死。免疫组织化学神经特异性烯醇酶(NSE)、突触素(Sy)、嗜铬素(CgA)证实神经内分泌分化。结论原发性子宫内膜小细胞癌极其罕见,文献报道极少。该肿瘤表现神经内分泌特征,具有较强侵袭性,预后极差。

Objective To report two cases of small cell endometrial carcinoma with discussion of clinical, histopathologic and immunohistochemical features. Methods Both cases underwent radical total hysterectomy with bilateral salpingo-oophorectomy and radical pelvic lymph node resection. The specimens were examined under microscope and studied by immunohistochemistry. Results Microscopic examination revealed sheets, cords, and nests of small or intermediate-sized cells with scanty cytoplasm, hyperchromatic nuclei, and a high mitotic rate. Single-cell and zonal necrosis were typically present. Immunohistochemical evidence of neuroendocrine differentiation was demonstrated by using markers as neuron-specific enolase, synaptophysin and chromogranin. Conclusion Primary small cell carcinoma of the endometrium is extremely rare, scarcely reported in the literature, and may exhibit evidence of neuroendocrine differentiation having a high propensity for systemic spread with poor prognosis. （Shanghai Med J, 2005, 28：758 760）