宫颈胃型腺癌九例临床病理分析

Clinicopathological Analysis of Nine Cases of Cervical Gastric-Type Adenocarcinoma

目的:分析宫颈胃型腺癌(gastric-type adenocarcinoma,GAS)的临床及病理特征,以期对疾病早诊断、早治疗,并改善预后。方法:回顾性分析我院2013年7月—2017年7月9例宫颈GAS患者的诊治、随访、病理形态、免疫组织化学特点等资料,并复习相关文献。结果:9例患者中位年龄44岁,6例术前确诊,2例术中确诊,1例术后确诊。临床表现上长期异常阴道排液者3例,宫腔积液者2例,此外,以附件肿物为主要临床表现者5例。总体生存时间平均104.3个月(95%CI:66.6~142.1个月)。12、24和36个月生存率分别为88.9%、77.8%和66.7%。宫颈GAS以向宫体侵袭为主,病理检查显示其与正常腺体差异小,免疫组织化学检查HIK1083、黏蛋白6(Mucin 6,MUC6)、细胞角蛋白7(cytokeratin 7,CK7)、CDX2、绒毛蛋白(villin)、配对盒基因8(paired box gene-8,PAX-8)、CA-125、CA-19-9、P16和癌胚抗原(carcinoembryonic antigen,CEA)均有较高的阳性率,CK20、PAX-2和P53阳性率低。结论:宫颈GAS临床罕见,易漏诊、误诊。但通过临床、影像及病理等多学科结合,有机会实现对宫颈GAS的早期诊治,提高患者的生存预期。

Objective:To analyze the clinical and pathological characteristics of gastric-type adenocarcinoma(GAS),in order to diagnose and treat the disease early and improve the prognosis.Methods:The diagnosis,treatment,follow-up,pathological morphology,immunohistochemical characteristics and other data of 9 cases of cervical GAS in Tianjin Central Hospital of Gynecology Obstetrics from July 2013 to July 2017 were retrospectively analyzed,and relevant literatures were reviewed.Results:The median age of 9 patients was 44 years old.6 patients were diagnosed in pre-operation,2 in intra-operation and 1 was in post-operation.There were 3 cases of long-term abnormal vaginal discharge,2 cases of intrauterine fluid and 5 cases of ovarian mass.The mean overall time to survival was 104.3 months(95%CI:66.6-142.1 months).The survival rates at 12 months,24 months and 36 months were 88.9%,77.8%and 66.7%respectively.The cervical GAS mainly invaded towards the uterine body.The pathological microscope showed little difference from the normal gland.Immunohistochemical analysis of HIK1083,Mucin 6(MUC6),cytokeratin7(CK7),CDX2,villin,paired box gene-8(PAX-8),CA-125,CA-19-9,P16 and carcinoembryonic antigen(CEA)showed high positive rates,while the positive rates of CK20,PAX-2 and P53 were low.Conclusions:Cervical GAS is rare and easy to be misdiagnosed.However,through the multidisciplinary combination of clinical,imaging and pathology,there is an opportunity to achieve the early diagnosis and treatment of GAS and improve the survival expectation.