26例子宫颈小细胞癌临床病理特征及预后分析

Analysis on clinicopathological characteristics and prognosis of small cell carcinoma of the cervix in 26 cases

目的探讨宫颈小细胞癌（SCCC）的临床病理特征及预后。方法收集26例原发性SCCC患者,回顾性分析其临床病理资料、特征及预后。结果 26例患者中,24例患者表现为宫颈接触性出血或不规则阴道流血,2例表现为月经不规则伴经期延长,妇检发现宫颈赘生物,其中15例为健康体检宫颈液基细胞学检查发现非典型细胞。26例患者中,ⅠB1期10例,ⅠB2期8例,ⅡA2期2例,ⅢB期4例,ⅣB期2例。组织学特点为肿瘤细胞不规则巢片状分布,瘤细胞大小及形态较一致,圆形或短梭形,细胞质少,核深染,核仁不明显,核分裂像多见,其中2例合并中分化腺癌,2例合并宫颈高级别上皮内瘤变（CINⅢ级）。26例患者均行免疫组织化学染色,细胞角蛋白（CK）阳性率为100%、细胞膜抗原（EMA）阳性率为84.6%、神经元特异性烯醇化酶（NSE）阳性率为100%、突触素（Syn）阳性率为92.3%、CD56阳性率为92.3%、嗜铬蛋白A（Cg A）阳性率为69.2%、TTF1阳性率为7.7%,Ki67阳性率为70%-90%。结论 SCCC少见,临床表现无特殊性,形态学与肺小细胞癌相似,瘤细胞表达联合神经内分泌标志物对诊断及鉴别诊断具有重要意义,其早期即可复发或转移,恶性程度高,预后差。

Objective To study the clinicopathological characteristics and prognosis of small cell carcinoma of the cervix（SCCC）. Methods 26 cases of patients with SCCC were selected,the clinical and pathological date was retrospectively analyzed,the clinicopathological characteristics and prognosis was analyzed. Results In 26 cases of patients,24 patients presented with symptoms of abnormal vaginal bleeding or postcoital spotting,2 patients presented with irregular menstruation,atypical cells were found through cervical liquid thin-layer cytology examination in 15 patients for physical examination.In 26 patients,10 patients were stage Ⅰ B1,8 patients were stage Ⅰ B2,2 patients were stage Ⅱ A2,4patients were stage ⅢB and 2 patients were stage ⅣB.Histological features showed that,tumor cells were irregular nests patchy distribution,size and shape of tumor cell was consistent,short round or spindle,cytoplasm was less,nuclear hyperchromatism,nucleoli was lack and nuclear fission like see was more,of which,2 cases of merger moderately fifferentiated adenocarcinoma,2 cases of merger cervical high-grade intraepithelial neoplasia（CIN） Ⅲ.26 patients were all taken with immunohistochemical staining,the positive rate of cytokeratin（CK） was 100%,of epithelial membrane antigen（EMA）was 84.6%,of neuron specific enolose（NSE） was 100%,of synaptophysin（Syn） was 92.3%,of CD56 was 92.3%,of Chromogranin A（Cg A） was 69.2%,of TTF1 was 7.7%,of Ki67 was 70%-90%. Conclusion SCCC is rare relatively,and has no special clinical manifestation,morphologically,it is similar to small cell cancer of lung,immunohistochemisty,tumor cells express neuroendocrine markers,recurrence and metastasis can be found in most patients early,and high malignant degree and poor prognosis.