宫颈小细胞神经内分泌癌五例临床病理分析

Clinicopathological study of 5 cases with small cell neuroendocrine carcinoma of the cervix

目的探讨宫颈小细胞神经内分泌癌(SCCC)的临床病理特征、免疫组化特点及鉴别诊断。方法采用光镜、免疫组化、原位杂交对5例SCCC进行观察,并回顾性分析其临床病理学特征及预后。结果 5例患者平均年龄43岁,均表现为不同程度的不规则阴道出血。组织学显示肿瘤细胞小而圆,胞质少,核染色质细颗粒状,核仁不明显,核分裂象活跃,瘤细胞呈片状浸润分布,常伴有坏死。3例合并腺癌,其中2例伴有HPV16/18型感染。免疫组化示5例均表达至少2种神经内分泌标志。结论宫颈小细胞癌是一种少见的高度恶性肿瘤,常伴有腺癌分化,并与HPV感染相关,其侵袭性强、预后差,具有独特的病理形态特征,免疫组化对诊断有一定帮助。

Objective To study the clinical and pathological features of small cell neuroendocrine carcinoma of cervix（SCCC）.Methods Clinical data,pathological changes,immunohistochimical and in situ hybridization histochemistry results were reviewed in 5 cases of SCCC.Results The average age was 43 years,and the main symptoms were vaginal bleeding.microscopically,these carcinomas showed infiltrating margins,small and round or spindle-shaped cells,scant cytoplasm,hyperchromatic nuclei,finely granular nuclear chromatin,absent or inconspicuous nucleoli,brisk mitotic activity and extensive necrosis.Three cases were associated with high-differentiated adenocarcinoma and two of them with HPV16/18 infection.SCCC respond positively to at least 2 of neuroendocrine markers.Conclusion SCCC is a rare but distinct HPV related cervical carcinoma,and often intermixed with a clonally related non-small cell component consisting of adenocarcinoma or squamous carcinoma.The presence of SCCC has an extremely aggressive biological behavior with a rapid clinical course.Neuroendocrine markers used in immunochemical methods were helpful to diagnosis.