子宫颈腺样基底细胞癌与腺样囊性癌的临床病理特点比较

Comparison of the clinicopathological features between adenoid basal cell carcinoma and adenoid cystic carcinoma of the cervix

目的探讨并比较宫颈腺样基底细胞癌和腺样囊性癌的临床和病理组织学特点,提高临床及病理医师对该类病变的诊断及鉴别诊断水平。方法对2009年3月至2019年4月解放军总医院第一医学中心病理科诊治的9例宫颈腺样基底细胞癌和3例腺样囊性癌病例进行回顾性研究,详细复习临床资料,复阅全部病理切片,观察EnVision法免疫组织化学结果,分析其临床病理学特征,电话随诊其预后并查阅相关文献。结果二者均以绝经后妇女多见(发病年龄43~74岁)。腺样基底细胞癌患者临床常无症状,多以体检时宫颈涂片异常就诊,阴道镜检查时常无肿块。而腺样囊性癌患者多以阴道异常出血就诊,阴道镜检查时常有肿块。组织学上两种病变的共同特点为肿瘤呈巢状生长,由基底样肿瘤细胞构成,细胞巢周围常有栅栏状结构。两种病变可以共存,也可与鳞状细胞癌或鳞状上皮内病变混合存在。不同点为腺样基底细胞癌多位于宫颈鳞柱交界区及上皮下,巢团中央伴鳞状分化,或呈双层腺样排列,细胞形态温和,核分裂象偶见,间质反应不明显;而腺样囊性癌细胞巢内肿瘤细胞多呈筛状排列,筛孔内见均质红染及蓝染分泌物,细胞异型性明显,核分裂象易见,有显著的间质反应,其中1例癌巢周围为肉瘤区域。二者人乳头状瘤病毒(HPV)检测多呈阳性,9例腺样基底细胞癌中3例行HPV检测,5例行p16检测,均呈阳性表达;3例腺样囊性癌中2例行HPV检测,3例行p16检测,均呈阳性表达。电话随访截至2019年6月,随访时间2~37个月,9例腺样基底细胞癌中7例未出现复发转移,1例出现肺部毛玻璃样结节,1例术后32个月出现阴道残端复发。腺样囊性癌1例术后8个月出现肺部转移,并于术后2年死亡;另1例随诊6个月无复发、转移;1例失访。结论宫颈腺样囊性癌和腺样基底细胞癌均是来源于宫颈储备细胞的肿瘤,与高危型HPV感染有关。因二者的临床处理方式和预后不同,应对二者进行仔细的组织学评估及免疫组织化学分析,作出准确的病理诊断。

Objective To compare the clinical and histopathological characteristics of cervical adenoid basal cell carcinoma and adenoid cystic carcinoma for improving the diagnosis accuracy and differential diagnosis of these tumors.Methods A retrospective study was conducted on 9 cases of cervical adenoid basal cell carcinoma and 3 cases of adenoid cystic carcinoma which were diagnosed and consulted at the First Medical Center of PLA General Hospital from March 2009 to April 2019.Detailed clinical data were reviewed.All pathological sections and immunohistochemical results were reviewed and the clinicopathological characteristics were analyzed.Follow-up information by telephone was collected and relevant literature was consulted.Results Both tumors were more commonly found in postmenopausal women(the age of onset ranged 43-74 years).Adenoid basal cell carcinoma was often clinical asymptomatic.Most of them presented as abnormal smears of the cervix during physical examination,and there was no definite mass in colposcopy.Adenoid cystic carcinoma was mostly presented with abnormal vaginal bleeding.A mass was seen in colposcopy.Histologically,the two tumors were characterized by nest-like growth of the tumors,consisting of basal-like tumor cells,and often surrounded by palisade structures.The two lesions might coexist,or be mixed with squamous cell carcinoma or high-grade squamous intraepithelial lesions.The difference was that adenoid basal cell carcinoma was mostly located at the junction of cervical squamous epithelium and columnar epithelium and beneath the overlying epithelium,the tumor cells were arranged in nests,with squamous differentiation in the center of the nests,or in double-layer adenoid arrangement.The cell morphology was bland with occasional mitoses,and the stromal reaction was not obvious.And adenoid cystic carcinoma cells in the nest arranged like a sieve,the homogenous red-stained and blue-stained secretions were observed in the sieve holes,with obvious cell atypia,frequent mitoses,and obvious stromal reaction.In one case of adenoid cystic carcinoma,sarcomatoid area presented around the nests.Both of them were positive in clinical HPV test.Among the 9 cases of adenoid basal cell carcinoma,3 were tested for HPV and 5 were tested for p16,and all showed positive expression.Among the 3 cases of adenoid cystic carcinoma,2 were tested for HPV and 3 were tested for p16,both of which showed positive expression.Telephone follow-up was conducted by June 2019(follow-up time ranged 2-37 months).No recurrence or metastasis occurred in 7 of the 9 cases of adenoid basal cell carcinoma,while 1 case had a ground-glass nodule in lung and another had recurrence of vaginal stump 32 months after the surgery.One case of adenoid cystic carcinoma developed lung metastasis 8 months after surgery and died 2 years after surgery;another case was followed up for 6 months,which showed no recurrence or metastasis;the third case was lost to follow-up.Conclusions Both adenoid cystic carcinoma and adenoid basal cell carcinoma of the cervix are the tumors originating from cervical reserve cells and are associated with high-risk HPV infection.Due to the differences in clinical treatment and prognosis,careful histological evaluation and immunohistochemical analysis should be carried out to make accurate pathological diagnosis.