宫颈腺样基底细胞癌5例临床病理学分析

Cervical adenoid basal cell carcinoma: a clinicopathological analysis of five cases

目的 探讨宫颈腺样基底细胞癌(ABC)的临床病理特点、诊断、鉴别诊断及预后。方法 收集5例宫颈ABC的临床病理资料,运用常规HE及免疫组化EnVision两步法检测,并对患者进行随访。结果 5例患者平均年龄64岁,均伴高危HPV感染,其中1例表现为宫颈接触性出血,4例无症状,阴道镜及大体标本均未见明显肿块,均行全子宫+双附件切除术。组织学类型:均为ABC合并高级别鳞状上皮内病变(HSIL)累及腺体;镜检:上皮下宫颈间质内见分化较好的基底样细胞呈小巢状、索状浸润性生长,癌巢周围细胞核呈栅栏状排列,部分癌巢中心可见囊性腔隙,也可见鳞状或腺样分化,浸润深度1.0~6.9 mm;免疫表型:P63及P40在ABC中呈阳性表达,在鳞状分化的区域表达减弱,腺样分化的区域表达缺失,P16及Bcl-2在ABC中呈弥漫强阳性,Ki-67在基底样细胞区域表达低于鳞状分化的区域,随访:术后随访25~48个月均未见复发或转移。结论 宫颈ABC好发于中老年妇女,常伴宫颈HSIL及高危型HPV感染,预后良好,需与鳞状细胞癌、腺样囊性癌等鉴别。

Objective To explore the clinicopathological features, diagnosis, differential diagnosis and prognosis of cervical adenoid basal cell carcinoma(ABC). Methods The clinicopathological data of 5 cases of cervical ABC were collected, detected by hematoxylin and eosin staining, immunohistochemical Elivision, and the patients were followed up. Results The average age of the 5 patients was 64 years old. All patients were accompanied with high-risk HPV infection, of which 1 case showed cervical contact bleeding and 4 cases were asymptomatic. No obvious mass was found in colposcopy and gross specimens. All patients underwent total hysterectomy plus double appendages resection. Histologically, all were ABC combined with high-grade squamous intraepithelial lesions(HSIL) involving glands. Under the microscope, well differentiated basal like cells were seen in the subepithelial cervical stroma, showing small nest and cord like invasive growth pattern. The nuclei around the cancer nest were arranged in a fence shape. Cystic cavities were formed in the center of some cancer nests, squamous or adenoid differentiation were also noted. Infiltration depths were 1.0-6.9 mm. Immunophenotypically, P63 and P40 were highly expressed in ABC, decreased in the area of squamous differentiation, and absent in the area of adenoid differentiation;P16 and Bcl-2 were diffusely and strongly positive in ABC;the expression of Ki-67 in the area of basal like cells was lower than that in the area of squamous differentiation. Follow-up showed that no recurrence or metastasis was found after 25-48 months. Conclusion Cervical ABC tends to occur in middle-aged and elderly women, often accompanied by cervical HSIL and high-risk HPV infection. It has a good prognosis and needs to be differentiated from squamous cell carcinoma and adenoid cystic carcinoma.