宫颈毛玻璃细胞癌临床病理观察

Clinicopathologic analysis of glassy cell carcinomas of cervix

目的探讨宫颈毛玻璃细胞癌(glassy cell carcinoma,GCC)的诊断、临床病理特征及免疫组化特点。方法分析3例宫颈GCC的临床特征、组织病理学诊断特点及免疫组织化学表达及HPV感染情况。对照组为宫颈基底细胞样鳞状细胞癌3例,腺癌3例,鳞状细胞癌3例及腺鳞癌3例,无肿瘤病变宫颈组织3例。结果 3例GCC患者平均33.7岁,症状为阴道流血,其中2例有明显肿块,1例无明显肿块,3例组织学特点相似,均为细胞呈巢状,小灶状分布,细胞界限清楚,肿瘤细胞呈毛玻璃样、胞质丰富、含大量嗜酸性颗粒、核膜薄、染色质细腻、核仁嗜酸性且较大。核分裂象及凋亡易见,间质有嗜酸性粒细胞、浆细胞浸润;免疫组化标记:p63、CK34βE12、CAM5.2、MUC1均阳性,HER-2有2例阳性(2/3),Ki-67指数80%,ER、PR、CK8、CK10、Syn、S-100均阴性。治疗均采取广泛全子宫切除+盆腔淋巴结清扫+术后辅助化疗,术后无癌生存时间3～28个月。结论宫颈GCC是腺鳞癌的特殊亚型,有独特的组织病理学特点及免疫组化表达谱,准确诊断该肿瘤对临床治疗有较大意义。

Objective To investigate the histological diagnosis and elinicopathological features of cervical glassy cell carcino- ma（GCC）. Methods The clinical characteristics, histology and immuuohistochemistry were analyzed in 3 cases of GCC And 3 cases of basalcell - like squamous carcinoma, 3 cases of adenocarcinoma, and 3 cases of cervical squamous carcinoma,3 cases of non - tumor cervical tissues were analyzed as control group. Results The average age of the patients were 33.7 years （26 - 44）. Abnormal vagi- nal bleeding was clinical presentation, two cases had an obvious mass in cervix, one case had no obvious mass ; all of the 3 cases pres- ented a similar histological features ： the tumor consisted of tumor cell clusters with distinct cell bounders, the tumor cells had glassy ap- pearance with thin menbrane and prominent nuclei. Mitosis and apoptosis were common. Eosinophils and plasma cells were present in the stroma. Immunohistochemistry： p63, CK34 βE12, CAM5.2, MUC1 were positive and 2 of the 3 cases were HER -2 positive while CK8, CK10, Syn, S - 100, ER and PR were negative. The Ki -67 index was 80%. All the 3 cases were treated by radical hysterecto- my, follwed by radiotherapy and chemotherapy, and the tumor free survival time ranged from 3 to 28 months. Conclusions GCC is a distinct variant of adenosquamous carcinoma of the cervix with special immunohistochemical profile ; the diagnosis of this kind of tumor is significant for clinical treatment.