子宫颈腺样基底细胞癌4例临床病理观察

Clinicopathologic study of cervical adenoid basal carcinoma

目的探讨子宫颈腺样基底细胞癌的临床病理特征、诊断、鉴别诊断及预后特点,以提高对该病的认识及避免过度治疗。方法对4例子宫颈腺样基底细胞癌的临床及病理资料进行回顾性分析,运用常规HE、免疫组化EnVision法染色及原位杂交技术进行检测,并复习相关文献。结果 4例子宫颈腺样基底细胞癌患者年龄53~67岁,平均61.5岁,4例患者均行全子宫+双侧附件切除术。镜下见癌组织由形态单一、分化良好的基底样小细胞组成,排列成小巢状或条索状。癌巢周边见栅栏状排列的细胞核,部分癌巢中央形成囊性腔隙,也可见腺样或鳞状分化。4例患者均伴子宫颈上皮内病变(cervical intraepithelial neoplasia,CIN)。免疫表型:肿瘤细胞CK5/6、CK8/18、CK19、p16、p40、p53、BCL-2和p63均阳性,ER、CK7、CEA、CD117和S-100均阴性。原位杂交检测:HPV16/18阳性。4例患者随访19~62个月,均未见复发及转移。结论子宫颈腺样基底细胞癌属于罕见但预后较好的肿瘤,因预后不同,需与腺样囊性癌、基底样鳞状细胞癌、神经内分泌癌及腺鳞癌鉴别。治疗可选择全子宫切除术或宫颈锥切术,不推荐放、化疗。

Purpose To study the clinicalpathologic features,diagnosis,differential diagnosis and prognosis of cervical adenoid basal carcinoma(ABC) for improving further recognition and avoiding the likelihood of unnecessarily aggressive treatment to this disease.Methods Clinical presentations and pathological features of 4 cases of cervical ABC were analyzed by hematoxylin and eosin staining,immunohistochemical En Vision staining and in situ hybridization technology.The relevant literatures were reviewed.Results The age of 4 cases with cervical ABC ranged from 53 to 67 years(mean:61.5 years).All of the4 patients underwent hysterectomy with bilateral salpingo-oophorectomy.Microscopically,the tumors were composed of small,well-differentiated and uniform basaloid cells and the tumor cells formed rounded nests or cords.The tumor cells arranged in palisading at the periphery of the nests.Some of the nests had central cystic spaces and there may also be focal glandular or squamous differentiation in the centre of the nests.Cervical intraepithelial neoplasia(CIN) lesions were observed in all 4 cases.Immunohistochemically,all the tumor cells were negative for CK7,ER,CEA,CD117 and S-100,while CK5/6,CK8/18,CK19,p16,p53,BCL-2 and p63 were positive.HPV 16/18 DNA were positive by in situ hybridization.The patients remained alive without recurrence and metastasis after follow-up 19 to 62 months.Conclusion ABC of the uterine cervix is a rare neoplasm with excellent prognosis.Differentiation of ABC from adenoid cystic carcinoma,basaloid squamous carcinoma,neuroendocrine carcinoma and adenosquamous carcinoma is important due to their different prognosis.Treatment is predominantly hysterectomy or laser electrocautery excision procedure(Leep).Radiotherapy or chemotherapy is not recommeded.