胃癌子宫转移2例并文献复习

Gastric cancer metastatic to uterus: A report of 2 cases and literature review

本文探讨胃癌子宫转移患者的临床病理特点、诊断及鉴别诊断。例1,患者女,40岁,以阴道少许出血就诊。病理显示在子宫内膜表浅间质内可见小灶分布的肿瘤细胞,大小形态较一致,细胞轻-中度异型性,细胞质嗜酸,部分细胞可见核仁,核分裂象罕见,部分区域累及子宫内膜腺体。免疫组织化学显示瘤细胞表达CEA、MUC6、MUC5AC、CK18、CK7、CK20、CDX2等消化系统来源标志物,不表达ER、PR及PAX8,D-240染色显示淋巴管癌栓。随后,该患者行胃镜检查,病理活检示胃低分化腺癌,形态与子宫内膜转移癌相似。例2,患者女,47岁,同样以阴道流血就诊,有胃癌病史。活检发现宫颈间质内见腺样排列或散在单个分布的癌细胞,免疫组织化学表达CK、CK20、CDX2等消化道来源标志物。胃癌子宫转移罕见,部分病例可无胃癌病史以阴道出血为首发症状就诊,极易误诊和漏诊,需仔细观察寻找证据,并加行免疫组织化学鉴别诊断。

In this paper,the clinicopathological features,diagnosis and differential diagnosis of two cases of metastatic gastric cancer to the uterus were discussed.Case 1 is a 40-year-old female who was hospitalized with light vaginal bleeding.The pathology showed the tumor cells were located in the superficial endometrial stroma,with focal distribution.The tumor cells had similar size and shape,mild-moderate atypia,and acidophilic cytoplasm.Nucleolus could be seen in some cells.Mitotic activity was rare.In some areas,endometrial glands were involved.Immunohistochemistry showed that the tumor cells were positive to CEA,MUC6,MUC5 AC,CK18,CK7,CK20,CDX2 and other original markers of digestive system,while negative to ER,PR and PAX8.D-240 staining showed lymph vessel tumor emboli.After endoscopic examination and biopsy,poorly differentiated gastric adenocarcinoma was confirmed.Case 2 is a 47-year-old female with vaginal bleeding too.Unlike case 1,she had a history of gastric cancer.The biopsy revealed adenoid or scattered tumor cells in the interstitium of the cervix.Immunohistochemistry showed that the cells were positive to CK,CK20,CDX2,and other original markers of the digestive system.The case of gastric cancer metastatic to uterus is rare.In some cases,the patients present with vaginal bleeding but without a history of gastric cancer are easily misdiagnosed or never diagnosed.To avoid misdiagnosis,it is important for us to be fully aware of this carcinoma and apply immunohistochemistry to differential diagnosis.