子宫内膜小细胞癌合并浆液性乳头状癌临床病理观察

Endometrial small cell carcinoma accompanied with papillary serous carcinoma: a clinicopathologic analysis

目的探讨子宫内膜小细胞癌(SCC)合并浆液性乳头状癌(PSC)的临床病理特征、诊断与鉴别诊断。方法分析1例原发性子宫内膜小细胞癌合并浆液性乳头状癌的临床表现、病理形态学特征及免疫组化特点,并结合文献进行讨论。结果患者女性,60岁。因绝经后不规则阴道出血入院。B超及MRI示子宫腔内实性占位性病变。行广泛全子宫、双附件切除及盆腔淋巴结清扫术。镜下肿瘤组织由SCC及PSC 2种组织学形态组成,2种成分穿插混合生长。SCC中,CD56和TTF-1(+),NSE、Cg A和Syn(-);CK、EMA、p16和p53两种成分均弥漫强(+)。患者术后给予放、化疗,随访6个月状况良好,无复发和转移。结论原发性子宫内膜SCC合并PSC非常罕见,易与子宫内膜腺癌伴去分化、子宫癌肉瘤、腺肉瘤、子宫内膜间质肉瘤、淋巴瘤等混淆。

Objective To study the clinicopathologic features, diagnosis, and differential diagnosis of small cell carcinoma （SCC） accompanied with papillary serous carcinoma （PSC） in the endometrium. Methods One case of primary small cell carcinoma with papillary serous carcinoma of the endometrium was investigated by clinical findings, histopathology and immunohistochemistry, and related literatures were reviewed. Results A 60-year-old women presented with postmenopausal bleeding. Ultrasound and magnetic resonance imaging （MRI） examination revealed a solid mass located within the uterine cavity. Total hysterectomy, bilateral salpingo-oophorectomy and pelvic lymph node dissection were performed. Microscopic examination revealed that the endometrial tumor composed of small cell carcinoma and papillary serous carcinoma. Immunohistochemically, SCC was positive for CD56 and TTF-1, but negative for NSE, CgA and Syn. SCC and PSC were both diffuse positive for CK, EMA, P16 and P53. The patient received radiation and chemotherapy after surgery. The patient had been well without evidence of disease for 6 months. Conclusions Primary small cell carcinoma accompanied with papillary serous carcinoma in the endometrium is a vel7 rare neoplasm. This tumor should be differentiated from uterine carcinnsareoma, uterine adenosarcoma, endometrial stromal sarcoma and lymphoma.