子宫颈原发性淋巴上皮瘤样癌8例临床病理分析

Clinic-pathologic characteristics of lymphoepithelioma-like carcinoma in cervix

目的探讨子宫颈原发性淋巴上皮瘤样癌（lymphoepithelioma-like carcinoma,LELC）的临床病理特征、组织学形态、鉴别诊断及预后。方法收集8例子宫颈原发性LELC的临床病理资料,行HE染色、免疫组化标记及原位杂交检测。结果 8例子宫颈原发性LELC患者发病年龄29~67岁,平均年龄44岁,临床分期均为ⅠB,淋巴结均无转移。眼观：5例子宫颈肿物呈菜花状,1例呈息肉样,其余呈浸润性增厚。镜下见肿瘤由未分化的大细胞组成,散在或成片巢状、条索状分布。瘤细胞呈卵圆形或多角形,细胞核空泡状,核膜清楚,可见1个或数个突出的嗜酸性核仁,细胞界限不清,呈＂合体样＂分布。瘤细胞间被丰富的淋巴细胞、浆细胞浸润。免疫表型：CK阳性率100%,p63阳性率37.5%,p16阳性率62.5%,CK5/6阳性率75%,Ki-67增殖指数10%-30%,间质淋巴细胞以CD3和CD8阳性表达为主。原位杂交检测EBER阴性,1例间质淋巴细胞弱阳性。电话随访截止2013年6月,1例死亡,其余7例均存活。结论子宫颈原发性LELC罕见,其是一种具有独特组织学形态的恶性肿瘤,临床预后较好,明确诊断依靠病理组织学和免疫组化标记。

Purpose To study the clinic-pathologic features,differential diagnosis and prognosis of lymphoepithelioma-like carcinoma of cervix. Methods Eight cases of lymphoepithelioma-like carcinoma of cervix were retrieved from our institution. HE staining,immunohistochemistry and in situ hybridization were perform on those cases. Results Of the 8 cases of lymphoepithelioma-like carcinoma,the median age was 44 years old（ ranged from 29-67 years） and all of the clinical stage belonged to ⅠB. Grossly,5 cases presented a cauliflower-like appearance,1 case grew as a polyp protrusion,and the other 2 cases showed a non-specified thicken change of cervix. Histologically,the tumors were composed of undifferentiated large cells,either loosely or closely-packed,with the nested and trabecular growth pattern. The tumor cells were generally oval or polygonal in shape,while the demarcation between the cells was indistinct and form the syncytial appearance. The nuclei were vesicular and had one or more prominent nucleoli. There were abundant infiltrates of lymphocyte and plasma cells among the tumor nests. The tumor cells showed positive expression of CK in 100% of cases,p63 in 37. 5% of cases,p16 in 62. 5% of cases,CK5 /6 in 75% of cases,Ki-67 in 10% ~ 30% of cases. The stromal lymphocytes mainly expressed CD3 and CD8. EBER was negative in the entire tumor cells while was weakly positive in the stromal lymphocytes in one case. The follow-up data,which terminated at June 2013,demonstrate 7 cases were alive and 1 case died of the disease. Conclusions Lymphoepithelioma-like carcinoma occurred of cervix is rare. They have distinctive morphologic features and overall favorable prognosis. The accurate diagnosis is dependant on the combination of the histologic and immunohistochemical examination.