宫颈腺样基底细胞癌临床病理观察

Clinicopathologic features of adenoid basal carcinoma of uterine cervix

目的进一步认识宫颈腺样基底细胞癌的病理形态及临床特点。方法应用细胞学、组织病理学、免疫组化等方法对1例宫颈腺样基底细胞癌进行分析,并结合相关文献讨论。结果液基涂片细胞学显示有异型的鳞状上皮细胞,符合高级别鳞状上皮内病变的形态学改变。光学显微镜下观察发现,宫颈鳞状上皮下方的间质内有圆形至卵圆形的小细胞巢,部分癌细胞巢的中央出现鳞状分化,周围呈栅栏状结构;肿瘤细胞巢与表面CIN3融合。免疫组化显示p63、p16和CK5/6(+),Ki-67灶状(+);宫颈间质内的部分血管平滑肌及纤维母细胞actin(+),而在癌巢周围呈(-)。结论宫颈腺样基底细胞癌罕见,具有独特的组织病理学特点。宫颈间质内的瘤组织易误认为鳞状上皮化生或被认为CIN累腺。诊断宫颈腺样基底细胞癌,须掌握严格的诊断标准,以作出正确诊断。

Objective To further study the pathological morphology and clinical features of the cervical adenoid basal cell carcinoma. Methods Cytological characteristics, histopathological changes and immunohistochemical findings were analyzed in 1 cases of cervical adenoid basal cell carcinoma and the related literatures were reviewed. Results Abnormal squamous epithelial cells were seen through the liquid-based preparation cytology test, which were highly consistent with the pathological changes of intraepithelial lesions. There were some cell nests in the stroma, and the center of some nests arounded by a palisade structure showed squamous cell differentiation. The tumor cell nests were sometimes associated with cervical intraepithelial neoplasia. Immunohistochemically, the tumor cells were positive forP63, P16 and CK5/6, and a few of them positive for Ki-67. Actin in cervical stroma within the vascular smooth muscle and fibroblasts were positive, and negative in surrounding of the carcinoma nests. Conclusions Cervical adenoid basal cell carcinoma is a rare malignant tumor, and it has characteristic histopathological features. The tumor within cervical stroma might be misdiagnosed as squamous metaplasia or considered as CIN involving gland. As diagnosis of cervical adenoid basal cell carcinoma, we should carefully analyse and grasp the strict diagnostic standard.