子宫颈小细胞癌35例临床病理分析

Cervical small cell carcinoma: a clinicopathologic study of 35 cases

目的探讨子宫颈小细胞癌(small cell carcinoma of the cervix,SCCC)的临床病理学特征、免疫表型、与人乳头瘤病毒(human papilloma virus,HPV)的关系及预后。方法采用免疫组化En Vision法对35例SCCC进行检测及PCR法进行HPV检测并分型。结果患者年龄29~76岁,中位年龄47岁。临床表现主要为不规则阴道出血。组织学上28例为单纯型小细胞癌,7例合并其他类型癌或癌前病变。镜下见小而深染的圆形或短梭形肿瘤细胞,呈巢状或条索状排列,胞质稀少,核仁不明显,坏死及核分裂象多见。免疫表型:神经内分泌标志物NSE(30/35)、CD56(27/35)、Syn(28/35)、CgA(20/35)阳性;其他标志物p16(29/35)、PAX-8(3/35)、TTF-1(15/35)及p63(12/35)阳性;Ki-67增殖指数均>50%。27例HPV检测结果为阳性,8例为阴性。29例随访时间3个月~6年,4例复发或转移,8例死亡。结论 SCCC组织学形态与其他部位小细胞癌类似,其发病与高危型HPV感染相关;常表达p16及TTF-1,PAX-8多呈阴性;预后差。

Purpose To study the clinicopathologic features and immunohistochemical characteristics of small cell carcinoma of cervix（SCCC）,and to explore the relationship between human papilloma virus（HPV） and SCCC,and prognosis of SCCC. Methods The clinical and pathologic findings of 35 cases of SCCC were retrospectively analyzed by HE staining and immunohistochemistry（En Vision method）. Multiplex fluorescent polymerase chain reaction method（PCR） was used to detect and classify the HPV on paraffin specimens. Results The patients ranged in age from 29 to 76 years（median,47 years）and most commonly presented with vaginal bleeding. The tumors were either pure SCCC（28） or mixed with other neoplasms（7）. Histologically,the small neoplastic cells arranged in solid sheets with a round,ovoid,or spindled hyperchromatic nuclei and scanty cytoplasm,the nucleoli were absent or inconspicuous. Mitotic rate and necrosis could easily been seen in all cases. Immunohistochemical findings showed that 30 cases were positive for NSE,27 cases for CD56,28 cases for Syn and 20 cases for Cg A. In addition,PAX-8 and TTF-1 were expressed in3 cases and 15 cases,respectively. Positivity for p16 was observed in 29 cases and the Ki-67 index was at least 50%. The HPV was detected in 35 cases by PCR with 27 positive cases. Of the 29 of 35 cases,the follow-up period was 3 months to 6 years,4 cases had recurrence or metastasis,and 8 died of SCCC. Conclusion SCCC is a highly malignant tumor with distinctively morphologic features and immunohistochemical characteristics,in which p16 and TTF-1 are commonly positive while PAX-8 often negative. It is possibily associated with high-risk HPV infection and has a poor prognosis.