宫颈复层产黏液性癌5例临床病理分析

Invasive stratified mucin-producing carcinoma:a clinicopathological study of four cases

目的探讨宫颈浸润性复层产黏液性癌(ISMC)的组织学特征、免疫表型和人乳头状瘤病毒(HPV)基因分型。方法回顾性分析4例ISMC和1例单纯复层产黏液上皮内病变(SMILE),并结合相关文献对ISMC和SMILE的临床病理特征、免疫表型、HPV基因分型及临床预后进行讨论。结果肿块切面多为灰白、灰黄色,实性,质中或稍硬。镜下ISMC肿瘤细胞排列呈复层,巢团状、实性片状,无明显腺样结构,呈浸润性生长。肿瘤细胞胞质内含多少不等的黏液,瘤巢中央可见中性粒细胞浸润。免疫组化显示p16、CK7弥漫强(+),CEA、IMP3(+),CK5/6局灶(+),Ki-67增值指数25%~70%;p40、ER及PR(-)。HPV检测显示,1例为高危型HPV-16(+),3例为高危型HPV-18(+),余1例未进行检测。结论宫颈浸润性复层产黏液性癌是一种较为少见的、具有特征性组织学改变的浸润性癌,发病与高危型HPV感染相关。目前研究认为,属于浸润性腺癌的特殊类型,治疗和预后与普通型腺癌相同。

Objective To investigate the histological feature,immunophenotype,differential diagnosis and prognosis of invasive stratified mucin-producing carcinoma(ISMC)in order to enhance the understanding of the disease.Methods Four cases of ISMC and 1 case of SMILE were collected,their pathological features and prognosis were observed,and the clinicopathological characteristics,immunophenotype and clinical prognosis of ISMC were analyzed and discussed in combination with relevant literatures.Results The section of the mass was gray or gray-yellow in color,and medium and hard in consistency.Postoperative pathological examination showed that tumor cells arranged in stratified epithelioid layer,palisading nests,and solid patchy infiltrating growth patterns,without obvious adenoid structure.The cytoplasm of the neoplastic cells contained variable amounts of mucus,and neutrophilic infiltration was seen in the center of the neoplastic nests.Immunohistochemical staining showed strongly diffuse expression of P16 and CK7;CK5/6 was focally positive;Ki-67 index was about 25%~70%,which meant high levels of the proliferation;and almost negative for P40,ER and PR.The high-risk HPV infection was detected;one case was positive for high-risk HPV-16,three were positive for high-risk HPV-18,and the remaining one was not tested.Conclusion Invasive stratified mucin-producing carcinoma is a relatively rare cancer,which is associated with high-risk HPV infection,and has specific histological characteristics.Current research suggests that it belongs to the special type of infiltrating adenocarcinoma.Furthermore,its treatment and prognosis are the same to the conventional adenocarcinoma.