子宫颈胃型腺癌35例临床病理分析

Clinicopathological features of 35 cases of gastric-type cervical adenocarcinoma

目的探讨子宫颈胃型腺癌(gastric-type cervical adenocarcinoma,GCA)的临床病理特征、诊断及鉴别诊断。方法收集35例GCA的临床病理资料,采用免疫组化EnVision两步法检测GCA石蜡组织中p53、p16、PAX2、HIK1083、MUC6等的表达,应用AB-PAS特殊染色检测其黏液性质,分析GCA的临床病理特征并复习相关文献。结果35例患者年龄28~75岁,平均51.1岁;临床表现最常见为异常子宫出血及阴道排液,部分病例肿瘤标志物CA19-9升高(15/24,62.5%);大部分病例FIGO分期处于进展期(Ⅱ~Ⅳ期)。免疫表型:p53突变型患者FIGO分期高于野生型患者(P<0.05);HIK1083(13/24,54.2%)、MUC6(27/30,90.0%)在部分GCA中呈阳性,PAX2均阴性。AB-PAS特殊染色示黏液均红染。结论GCA组织学复杂多样,根据组织学特征并联合应用AB-PAS特殊染色及免疫组化染色可进行准确诊断。

Purpose To explore the clinical and pathological characteristics,diagnosis,and differential diagnosis of gastric-type cervical adenocarcinoma(GCA).Methods The clinicopathological data of 35 cases of GCA were collected,immunohistochemical EnVision two-step method was used to detect the expression of p53,p16,PAX2,HIK1083 and MUC6 and so on,and AB-PAS special staining to detect the mucus property in paraffin-embedded tissue of GCA.The clinicopathological features were analyzed and the relevant literatures were reviewed.Results The age of 35 patients ranged from 28-75 years and the mean age was 51.1 years.The most common clinical characteristics included abnormal uterine bleeding and vaginal discharge.Tumor marker CA19-9(15/24,62.5%)was elevated in some cases.Most cases were in advanced FIGO stage(fromⅡtoⅣ).Histopathological characteristics were complex.Patients with p53 mutant expression were in higher level FIGO stage than those with wild-type p53 expression(P<0.05).Some cases were positive for HIK1083(13/24,54.2%)and MUC6(27/30,90.0%).All cases were negative for PAX2 and red in AB-PAS mucus staining.Conclusion GCA is aggressive in biological behavior.Histological morphology of GCA is complex and variable.Accurate diagnosis depends on histomorphology,AB-PAS special staining and immunohistochemical expression.