子宫颈原发性透明细胞癌五例临床分析

Primary clear cell carcinoma of the cervix： report of five cases and review of the literature

目的探讨宫颈原发性透明细胞癌的临床诊治特点及预后相关因素。方法收集中山大学附属第二医院2003年1月至2006年12月收治的5例宫颈原发性透明细胞癌患者的临床病理及随访资料，进行回顾性分析。结果5例宫颈原发性透明细胞癌患者的临床分期：1例Ⅰ b1期，2例Ⅰb2期，1例Ⅱ a期，1例Ⅳ a期；平均年龄40．2岁（32～50岁）；首发症状主要表现为不规则阴道流血，占3／5；大部分肿瘤为内生型，占4／5。宫颈细胞学检查的阳性率为2／4，宫颈人乳头状瘤病毒（HPV）DNA检测的阴性率为4／4。血清CA，。水平于术前及复发时升高，范围为62．5～592．1kU／L，术后恢复至正常水平。5例患者中3例肿瘤浸润至宫颈深1／2肌层，2例浸润至颈体交界处。5例患者均行手术治疗，4例行广泛性子宫切除＋盆腔淋巴结切除术，术后辅以氟尿嘧啶（5-Fu）＋卡铂静脉化疗4个疗程，其中1例Ⅱa期患者另辅以腔内放疗，此4例患者随访期内（10～44个月）均无复发转移；1例Ⅳa期患者首次手术方式为子宫＋直肠前肿物切除术，术后3个月盆腔复发，后行二次手术，术后辅以盆腔外照射＋腔内放疗，并予紫杉醇＋卡铂静脉化疗8个疗程，随访26个月无再次复发转移。结论宫颈原发性透明细胞癌发病可能与HPV感染无关，肿瘤以内生型为主，倾向于向宫颈深部浸润及向宫体扩散，手术联合铂类与5-Fu或紫杉醇化疗的综合治疗方案有较理想的近期疗效，血清CA125水平有助于预后监测。

Objective To explore the clinical diagnostic and therapeutic characteristics, prognostic factors of patients with primary clear cell carcinoma of the cervix. Methods The clinical, pathologic and follow-up data of patients with primary clear cell carcinoma of the cervix treated in our hospital from Jan 2003 to Dec 2006 were collected and analyzed retrospectively. The relative literature was reviewed. Results Five patients with primary clear cell carcinoma of the cervix were treated （ 1 case stage Ⅰ b1, 2 of stage Ⅰ b2, 1 of stage Ⅱa, 1 of stage Ⅳa）. The mean age was 40.2 years （32 to50 years）. The primary symptom was mostly irregularly vaginal bleeding （ 3/5 ） and clinical type was predominantly （4/5） endophytic growth. The positive rate of cervical cytologic examination was 2/4, the negative rate of cervical human papillomavirus （HPV） DNA examination was 4/4. Serum CA125 level was abnormal （62. 5 to 592. 1 kU/L） before operation and when relapse occurred, and returned to normal after operation. All of five patients underwent operation, pathologic examination showed that three patients with infiltration in deep 1/2 myometrium of cervix, and two patients with infiltration in cervix-corpus juncture. Four patients underwent radical abdominal hysterectomy with systematic pelvic lymphadenectomy. All of four patients underwent four courses of chemotherapy with fluorouracil （5-FU） and carbeplatin, one patient （stage Ⅱ a） was added with intracavitary brachytherapy. None of the four patients had relapse or metastasis after a follow-up of 10 to 44 months. The patient with stage Ⅳ a underwent firstly hysterectomy and prerectum mass removal. Pelvic relapse occurred three months after operation and the patient then underwent the second operation, external beam radiotherapy and intracavitary brachytherapy and 8 courses of chemotherapy with paclitaxel （ taxol ） and carbeplatin. There was no relapse or metastasis after a follow-up of 26 months. Coaclusions Primary clear cell carcinoma of the cervix may be unrelated to HPV infection. It shows predominantly endophytic growth and tends toward deep infiltration in cervix and extending to uterine corpus. Operation combined with chemotherapy with carboplatin and 5-FU or taxol may lead to relatively perfect short-term therapeutical effect. Serum CA125 can help to monitor prognosis.