子宫颈鳞状移行细胞癌临床病理分析及组织分化观察

Clinical pathology and histodifferention analysis of squamous transitional carcinoma of the cervix

目的:探讨子宫颈鳞状-移行细胞癌的临床病理、免疫表型、诊断和鉴别诊断。方法:按2003年WHO宫颈肿瘤分类标准观察5例宫颈鳞状移行细胞癌患者的临床病理特点,应用免疫组织化学方法对宫颈活组织和手术标本进行组织形态和免疫表型的检测。结果:患者年龄中位数为45岁,临床主要表现为阴道异常出血,肉眼子宫颈肥大、呈颗粒状、息肉样或菜花样新生物(4/5)。显微镜下未见明显挖空细胞,呈移行或鳞状细胞样分化,部分似有腺细胞样分化。组织形态学:肿瘤由纤维血管轴心的乳头状结构构成,乳头由多层异型鳞状及移行细胞样上皮覆盖。2例非浸润性,2例乳头间质浸润,1例子宫颈壁浸润;免疫组化显示P16和细胞角蛋白(cytokeratin,CK)19和CK5/6均强阳性,CK7阳性强弱不等,1例CK20上皮表层灶状阳性,余为阴性;4例高危型HPV检测阳性。结论:鳞状移行细胞癌是兼有鳞状-移行细胞形态和一定腺样分化的非腺性乳头状鳞状细胞癌,它与高危型HPV感染相关,具有向乳头间质和宫颈壁浸润、复发及转移的特点。鳞状移行细胞癌需与宫颈其他乳头状肿瘤鉴别。

Objective： To explore the clinicopathological and differentiated features of squarno-transitional carcinoma（STCC）. Methods： Five patients with squamo-transitional carcinoma were reviewed according to the classification of uterine tumors provided by WHO in 2003. Results： The median age of 5 patients was 45 years old. The patients mainly presented abnormal hemorrhage in vagina, uterine cervix hypertrophy, polypoid or cauliflower-like neoplasia. Cytologicall）5 it displayed differentiation of migration, squamous cell or glandular cell without obvious koilocytotic cell. Histologicall）5 it showed papillary squamo-transitional stratified epithelium with fibrous andvessel stroma. Two patients did not display invasion while 2 or 1 showed papillal stroma or wall of cervix invasion. Immunohistochemically, the tumor cells showed positive for P16, CK19, CK5/6, and CK 7. Only one was positive for CK 20 and 4 patients were HPV positive. Conclusion： STCC is an uncommon type of papillary squamous cell carcinoma with squamo-transitional and certain gland features, and it is related to high risk of HPV infection with features of invasion, recurrence, and metastasis. STCC should be differentiated from other corpora mammillaria tumors of cervix.