原发性子宫颈小细胞癌18例临床病理观察

Clinicopathological study on 18 cases of primary cervical small cell carcinoma

目的探讨原发性子宫颈小细胞癌（small cell carcinoma of the cervix,SCCC）的临床病理学特征、免疫表型及预后。方法采用免疫组化SP法和原位杂交法对18例SCCC进行临床病理学观察,并结合文献复习。结果 18例SCCC患者年龄30~69岁,平均40岁。SCCC患者临床表现均为阴道不规则出血。妇科检查：子宫颈肿块或子宫颈糜烂。组织学特征：SCCC肿瘤细胞小而一致,可呈圆形似淋巴细胞,但较淋巴细胞大,或呈雀麦形,或部分呈短梭形,细胞质少,境界不清,核染色质呈细颗粒状,深染,核仁不明显,核分裂象多见。免疫表型：肿瘤细胞通常表达CKpan,并不同程度地表达Syn、NSE、Cg A、CD56和p16。原位杂交：检测4例肿瘤细胞HPV 16/18阳性。超微结构：肿瘤细胞内可见神经内分泌颗粒。随访10例SCCC,6例患者2年内死亡。结论 SCCC属神经内分泌癌,是子宫颈少见的高度恶性肿瘤,预后差,其发生可能与HPV 16/18感染有关。CKpan、Syn、Cg A、NSE和CD56是SCCC的免疫标志物,有利于辅助诊断。

Purpose To investigate the clinicopathological and immunohistochemical features of primary small cell carcinoma of the cervix（ SCCC） and its prognosis. Methods 18 cases of primary cervical small cell carcinoma were evaluated by histopathology,in situ hybridization and immunohistochemistry and relevant literatures were reviewed. Results The age of the patients ranged from 30 to69 years（ mean age,40 years）. Major clinical manifestation was irregular colporrhagia. Colposcopy often revealed a cervical mass or cervical erosion. Microscopically,the tumor cells were small and round and arranged in a solid distribution. The cell had little cytoplasm and increased karyoplasmic ratio with deeply stained granular chromatin and increased pathological mitosis. Immunohistochemically,the tumor cells were often positive for CKpan,variable positive for Syn,NES,Cg A,CD56 and p16. HPV 16 /18 were positive in 4 cases. Conclusion SCCC is a neuroendocrine tumor of high malignancy and poor prognosis with a possible pathogenesis of HPV16 /18 infection. CKpan,Syn,Cg A,NSE and CD56 are useful markers for the diagnosis of SCCC.