女性生殖道同期发生的黏液上皮化生和肿瘤

Synchronous mucinous metaplasia and neoplasia of the female genital tract

目的探讨女性生殖道同期发生的黏液上皮化生和肿瘤的临床病理特征。方法收集2014年11月至2017年9月复旦大学附属妇产科医院诊断的7例女性生殖道同期发生的黏液上皮化生和肿瘤患者资料，复习所有病理切片，免疫组织化学采用PAP法，并收集随访结果。结果7例患者年龄37-70岁，平均54岁。7例患者均见子宫内膜的黏液性病变。3例为宫颈胃型腺癌合并微偏腺癌。3例为宫颈叶状增生、不典型叶状增生合并局灶原位胃型腺癌，并且其中1例伴有早期浸润性胃型腺癌。1例患者宫颈局灶见简单型胃型黏液化生，子宫内膜的黏液化生性病变呈现叶状增生的结构。7例中6例输卵管见黏液上皮分化，3例卵巢见黏液性囊腺瘤。6例p16阴性，1例p16阳性。所有病灶细胞角蛋白（CK）7弥漫阳性，CK20和CDX2阴性或局灶阳性，黏蛋白（MUC）6呈弥漫阳性或灶性阳性。p53在胃型腺癌区域及原位胃型腺癌区域呈突变型表达，而在微偏腺癌区域呈野生型表达。随访2-34个月未见复发。结论女性生殖道同期发生的黏液上皮化生和肿瘤是累及女性生殖道的多灶性黏液性病变，具有胃型分化的特点，包括胃型分化的各种良性或恶性病变，且与高危人乳头状瘤病毒感染无关。当发现宫颈有胃型分化的腺体时，诊断性刮宫及检查卵巢和输卵管是必要的，需与转移性黏液性癌鉴别。

Objective To describe the clinicopathological features of synchronous mucinous metaplasia and neoplasia of the female genital tract （SMMN-FGT）. Methods The sample consisted of 7 cases of SMMN-FGT recorded from November 2014 to September 2017 at Obstetrics and Gynecology Hospital, Fudan University. PAP method was used in immunohistochemistry. Clinical histories were retrieved and pathological slides were reviewed. Results The patients were 37 to 70 years old（mean 54 years old）. All patients showed endornetrial mucinous lesions associated with cervical lesions. Three cases were an admixture of minimal deviation adenocarcinoma（MDA） and gastrictype adenocarcinoma（GAS）. Three cases were an admixture of lobular endocervical glandular hyperplasia （ LEGH ） , atypical LEGH and focal gastrictype adenocarcinoma in situ, one of which had early invasive gastrictype adenocarcinoma. Endometrium showed a structure of LEGH in one patient with focal simple gastric mucinous metaplasia in her cervix. Gastric mucinous differentiation was found in unilateral fallopian tube in 6 patients. Ovarian mucinous lesions were found in 3 patients, p16 was negative staining in 6 cases and positive in 1 case. CK7 was diffusely positive in all lesions. CK20 and CDX2 were negative or only focally positive. The expression of MUC6 was strongly positive staining or focal staining, p53 in GAS and GAS in situ had mutant expression, but wild expression in MDA region. Patients were followed up for 2 to 34 months and no recurrence was found. Conclusions SMMN-FGT is a series of rare mucinous lesions involving multiple areas of the female genital tract, including benign or malignant lesions with gastric differentiation. It is not related to infection with high-risk human papilloma virus. When cervical gastrictype lesions are found, SMMN-FGT should be considered and should be differentiated from metastatic mucinous adenocarcinoma.