子宫颈浸润性复层产黏液的癌6例临床病理分析

Clinicopathological observation of cervical invasive stratified mucin-producing carcinoma

目的探讨子宫颈浸润性复层产黏液的癌(invasive stratified mucin-producing carcinoma,ISMC)的临床病理学特征及预后。方法回顾性分析2019~2021年褔建省肿瘤医院诊治的6例子宫颈ISMC的临床病理学及免疫表型特征,并复习相关文献。结果6例均可见经典的ISMC形态,实性癌巢由胞质内黏液多少不等的复层上皮细胞组成,边界较圆钝,巢周细胞呈栅栏状排列,类似子宫颈产黏液的复层上皮内病变。转移灶与原发灶形态一致或癌巢较不规则。免疫表型:肿瘤细胞p16、CEA、CK7、CK8/18均阳性,ER、PR、PAX8和Syn均阴性,CK5/6、p40阴性或灶性阳性,Ki-67增殖指数为70%~80%。结论子宫颈ISMC是新近命名的HPV相关的腺癌亚型,具有独特的形态学及免疫表型特征,预后较其它HPV相关腺癌差,识别子宫颈癌中ISMC成分具有临床意义。

Purpose To investigate the morphological and prognosis features of cervical invasive stratified mucin-producing carcinoma(ISMC).Methods 6 ISMCs diagnosed and treated in Fujian Provincial Cancer Hospital in 2019-2021 were collected.The histological morphology,immunohistochemical expression of 6 ISMCs were evaluated by HE staining and immunohistochemistry.The diagnosis,differential diagnosis and prognosis of 6 cases of ISMC were analyzed and revelant literatures were also reviewed.Results 6 ISMCs showed classic morphology such as solid nests filled with stratified tumor cells with variable amounts of intracytoplasmic mucin,and with nuclear palisading along the periphery of the nests,similar to the in situ counterpart(stratified mucin-producing intraepithelial lesion,SMILE).Metastatic ISMC may be more irregular growth than primary tumors.Immunohistochemically,the tumor cells in 6 ISMCs were positive for p16,CEA,CK7,and CK8/18,but negative for ER,PR,PAX8,and Syn,CK5/6 and p40 were negative or focal positive,and the proliferating inidex of Ki-67 was 70%-80%.Conclusion ISMC is a recently decribed human papillomavirus(HPV)-associated adenocarcinoma subtype of the uterine cervix with phenotypic plasticity and aggressive clinical behavior.It maybe have a worse clinical outcomes compared to other HPV-associated subtypes.To identify ISMC composition of cervical cancinoma has clinical significance.