宫颈肉瘤样癌:罕见的病理学实体

Sarcomatoid carcinoma of the cervix: a rare entity

目的探讨宫颈肉瘤样癌的临床病理特征、诊断与鉴别诊断。方法对1例宫颈肉瘤样癌的临床表现、组织学形态及免疫表型进行分析,并复习相关文献。结果患者女性,48岁。因阴道排液2个月入院。妇科检查:宫颈处见一个直径3 cm的结节型肿块。镜下见肿瘤细胞由单一的肉瘤样成分构成。免疫组化:肿瘤细胞上皮性标记物(AE1/AE3、CK7)和间叶性标记物(vimentin、CD10、SMA、caldesmon)及p16均(+);desmin、CK5/6、p63、CEA、PR、ER、CD21、S-100、ALK和p53均(-)。结论宫颈肉瘤样癌是一种罕见的病理学实体,迄今仅有<20例报道,熟悉其临床病理学特点及其免疫表型,有助于其正确诊断。

Objective To report the clinicopathological characteristics, diagnosis and differential diagnosis of sarcomatoid carcinoma of the cervix. Methods The clinical features, histopathological changes and immunohistochemical findings were analyzed in one case of sareomatoid carcinoma of the cervix with review of the related literature. Results A 48 years old patient presented with the complaint of abnormal vaginal discharge for the past 2 months. Physical examination revealed a 3 cm diameter cervical mass. Microscopically, the tumor was composed of a singly sarcomatoid component. Immunohistochemistry demonstrated coexpression of epithelial markers （AE1/AE3, CK7 ） , mesenchyrnal markers （vimentin, CD10, SMA, caldesmon）, and p16 in tumor cells, which favors a gland epithelial origin of sarcoma-like component and an association with HPV infection; and negative for desmin, CK5/6, P63, CEA, PR, ER, CD21, S-100, ALK and p53. Conclusions Sareomatoid carcinoma of the cervix is a rare entity, with less than 20 reported cases in the English literature. A comprehensive evaluation of clinical manifestations, pathologic features and immunohistochemical findings is essential for definitive diagnosis.