宫颈中肾腺癌1例并文献复习

Mesonephric adenocarcinoma of uterine cervix:a case report and literature review

目的探讨宫颈中肾腺癌(MA)患者的临床表现、诊断、治疗和预后。方法选择2021年12月于空军军医大学第一附属医院(西京医院)就诊的1例MA患者(患者1)为研究对象。采用回顾性分析法,收集患者1入院后检查结果、主要治疗经过、预后及病理学检查结果。以"宫颈""中肾腺癌""uterine cervix""mesonephric adenocarcinoma"等为中、英文关键词,自中国知网、万方数据库、维普中文科技期刊数据库及PubMed文献数据库中,检索关于宫颈MA相关研究文献。本次文献检索时间设定为上述数据库建库至2023年2月。本研究通过空军军医大学第一附属医院(西京医院)医学伦理委员会的批准(伦理委员会批号:KY20222112-C-1),并与患者1签署知情同意书。结果①患者1以不规则阴道流血为首发症状,影像学检查提示可疑宫腔及宫颈占位,宫腔及宫颈组织活检结果提示为腺癌,遂进行经腹广泛性全子宫、双附件、大网膜切除术+盆腔、腹主动脉旁淋巴结清扫术+腹壁脂肪瘤切除术,术后对其采取紫杉醇+卡铂方案化疗4个疗程,随访1年无复发、转移。②文献复习结果:根据本研究设定的文献检索策略,检索涉及关于宫颈MA患者研究的相关文献为25篇,共计纳入27例MA患者(患者2~28)进行研究,结合患者1,共计28例MA患者。这28例患者的发病中位年龄为57岁(27~77岁);19例(19/28,67.9%)患者(患者1~5、7、9、12~14、18~22、24~27)的临床症状为不规则阴道出血,包括绝经后阴道出血。50.0%(9/18)(患者2~3、7、16、21~22、25~27)在妇科查体发现宫颈赘生物。33.3%(8/24)(患者6、10、13、16、21、23~24、27)术前被确诊为MA。78.9%(15/19)(患者1~2、4~7、9、12~14、18、20~22、27)宫颈MA患者确诊时为Ⅰ~Ⅱ期。28.6%(6/21)(患者8、13、15~16、18~19)在随访期内发生宫颈MA复发或转移。结论宫颈MA患者预后差,病理学诊断依赖术后切除组织或宫颈锥切组织的免疫组化染色,其治疗及预后,则尚需患者样本积累。基因检测或许可为宫颈MA提供靶向治疗依据。

Objective To investigate clinical manifestations,diagnosis,treatment and prognosis of mesonephric adenocarcinoma(MA)of uterine cervix.Methods A patient(patient 1)with MA in the Xijing Hospital of Air Force Medical University in December 2021 was selected in this study.Retrospective analysis was used to collect the examination results,main treatment course,prognosis and pathological examination results of patient 1 after admission.With"cervix""adenocarcinoma of middle kidney""uterine cervix"and"mesonephric adeno carcinoma"as Chinese and English key words,the related literatures about cervical MA were searched from CNKI,Wanfang Database,VIP Chinese Sci-tech Journal Database and PubMed.The literature retrieval time was set from the establishment of the above databases to February 2023.This study was approved by the Medical Ethics Committee of the Xijing Hospital of Air Force Medical University(Approve No.KY20222112-C-1 C-1),and the informed consent was signed by the patient.Results①The first symptom of patient 1 was irregular vaginal bleeding.Imaging examination revealed suspicious uterine cavity and cervical mass,and uterine cavity and cervical biopsy revealed adenocarcinoma.Then,abdominal extensive total hysterectomy,double appendages,greater omentum resection+pelvic cavity,abdominal paraaortic lymph node dissection+abdominal lipoma resection were performed,and paclitaxel+carboplatin regimen chemotherapy was performed for 4 courses after operation.There were no signs of recurrence and metastasis after one year of follow-up.②Review of the literature:According to the literature retrieval strategy set by this study,25 articles were retrieved involving cervical MA patients,with a total of 27 MA patients.Combined with the patient 1 in this study,there were a total of 28 MA patients.The age of onset ranged from 27 to 77 years,with a median age of 57 years.The most common clinical symptoms in the 28 patients were irregular vaginal bleeding(19/28,67.9%),including postmenopausal vaginal bleeding.Conclusions Cervical MA has a poor prognosis,pathological diagnosis depends on immunohistochemical staining,and treatment and prognosis still need a large number of cases to accumulate.Gene detection can provide a basis for targeted treatment of renal adenocarcinoma in cervix.