原发性宫颈透明细胞腺癌合并宫颈子宫内膜异位症临床病理观察

Clinicopathological features of primary cervical clear cell adenocarcinoma with cervical endometriosis

目的探讨原发性宫颈透明细胞腺癌(PCCAC)合并宫颈子宫内膜异位症的临床病理学特点、诊断、治疗及预后。方法采用HE染色和免疫组织化学染色分析2例PCCAC合并宫颈子宫内膜异位症的临床表现、病理学及免疫组化表型特征,并复习相关文献。结果2例均为绝经后患者,分别以绝经后阴道出血及体检发现宫颈下部低回声起病。镜下见肿瘤由体积较大的透明细胞组成,胞质丰富、透亮,界清,排列呈乳头状。2例均合并宫颈子宫内膜异位症,例1免疫组织化学表型为Napsin A及CK7(+),p53(灶状+,野生型),Ki-67(40%),CEA、ER、CD10、p16、PR、vimentin、WT-1及CD15均(-)。FIGO分期均为I B1期。结论PCCAC是一种少见的宫颈癌类型,发病机制可能与子宫颈内膜异位症有关,确诊主要依靠病理检查及免疫表型,治疗以手术联合放化疗等综合治疗方案为宜,早期诊断是预后的关键因素。

Objective To investigate the clinical pathological features,diagnosis,treatment and prognosis of primary clear cell adenocarcinoma of the cervix(PCCAC)combined with cervical endometriosis.Methods HE staining and immunohistochemical staining were used to analyze the pathology and immunohistochemical phenotypes in 2 patients with PCCAC and cervical endometriosis.Results Both cases were postmenopausal patients:the first symptom of Case 1 was post-menopausal vaginal bleeding and Case 2 was cervical mass revealed by physical examination.Microscopically,the tumor was composed of large clear cells with abundant translucent,cytoplasm,clear boundary and arranged papillary.In both cases,patients were combined with cervical endometriosis.The immunohistochemical staining of Case 1 was Napsin A(+),CK7(+),p53(focal+,wild type);Ki67 index was about 40%;CEA,ER,CD10,p16,PR,vimentin,WT-1 and CD 15 were negative.According to the FIGO staging criteria,both cases were I B1.Conclusion PCCAC is a rare type of cervical cancer and the pathogenesis may be related to cervical endometriosis.The diagnosis depends mainly on pathological examination and immunophenotype.The treatment strategy was surgery combined with radiotherapy and chemotherapy.Early diagnosis is a key factor in prognosis of PCCAC.