宫颈腺样基底细胞癌6例临床病理分析

Cervical adenoid basal carcinoma:Six cases of clinicopathological analysis

目的:宫颈腺样基底细胞癌(cervical adenoid basal carcinoma,CABC)是一种罕见的宫颈肿瘤,恶性程度低,预后良好,但临床上容易误诊。本研究旨在通过探讨CABC的临床病理特点、免疫表型、诊断、鉴别及预后以提高对该肿瘤的认识。方法:收集6例CABC的临床病理资料行光镜观察及免疫组织化学染色,并复习相关文献。结果:6例患者均为绝经后女性,年龄为62~73岁。4例患者无明显临床症状,因宫颈细胞学检测异常而就诊;1例因绝经后阴道出血就诊;1例因外阴恶性肿瘤就诊。3例行人乳头瘤病毒(human papilloma virus,HPV)检测,结果为阳性,1例复查提示HPV阳性。6例患者均行全子宫+双附件等手术切除。大体观:6例宫颈处均未见明显肿物,均可见不同程度的宫颈外口糜烂。镜检:肿瘤由小而圆的基底样细胞构成实性或筛状细胞巢,在宫颈的浅表间质中呈浸润性生长,浸润深度2~6 mm,细胞巢周围间质反应不明显,其中1例癌巢周围间质黏液样变性;肿瘤细胞巢外围细胞呈栅栏状排列,部分巢中央有腺样或筛样;肿瘤细胞体积小,形态温和一致,排列紧密,核呈圆形或椭圆形,细胞质稀少,核分裂象偶见,2例部分肿瘤细胞巢呈鳞状细胞分化。其中5例合并高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)累及腺体,1例合并鳞状细胞癌。免疫表型:P16为弥漫阳性,细胞角蛋白(cytokeratin,CK)5/6、P63和P40均为阳性,3例行CD117检测为阴性,Ki-67表达具有异质性,鳞状分化区域阳性指数较高,基底细胞样区域及腺样结构区域阳性指数低,阳性率为5%~20%。6例患者术后随访5个月至7年,均无复发和转移。结论:CABC是一种罕见的低度恶性的宫颈肿瘤,预后良好,罕见转移,肿瘤总体预后取决于合并的其他肿瘤类型。

Objective:Cervical adenoid basal carcinoma(CABC)is a rare cervical tumor with low malignant potential and a good prognosis,but it is often misdiagnosed clinically.This study aims to improve understanding of this tumor by exploring its clinicopathological features,immunophenotype,diagnosis,differentiation,and prognosis.Methods:Clinicopathological data of 6 cases of CABC were collected for light microscopy observation and immunohistochemical staining.Related literature was also reviewed.Results:The 6 cases were all postmenopausal women,aged 62 to 73 years.Four cases had no obvious clinical symptoms and were diagnosed due to abnormal cervical cytology;1 case presented with postmenopausal vaginal bleeding,and 1 case with malignant tumor of the vulva.Human papillomavirus(HPV)testing was positive in 3 cases,with 1 case showing positive on retesting,and the results were positive.All 6 cases underwent total hysterectomy with double appendages resection.Grossly,no obvious masses were found in the cervix,but various degrees of cervical erosion were observed.Microscopically,the tumor consisted of small,round basaloid cells arranging solid or cribriform nests,infiltrating the superficial stroma of the cervix with depth of 2 to 6 mm.The stroma reaction around the nests was not obvious,with mucinous degeneration seen around nests in 1 case.The peripheral cells of the tumor nests were arranged in a fence shape,with some nests showing glandular or cribriform differentiation in the center.The tumor cells were small,uniform in shape,closely packed,with round or oval nuclei,sparse cytoplasm,occasional mitotic figures,and squamous cell differentiation in some nests of 2 cases.Five cases were associated with high-grade squamous intraepithelial lesion(HSIL)involving glands,and 1 case was associated with squamous cell carcinoma.Immunophenotypically,P16 was diffusely positive,while cytokeratin(CK)5/6,P63,and P40 were positive.CD117 testing in 3 cases was negative.Ki-67 expression showed heterogeneity,with higher positive rates in squamous differentiation areas and lower positive rates in basal cell-like areas and glandular structures,ranging from 5%to 20%.All 6 cases were followed up for 5 months to 7 years,with no recurrence or metastasis.Conclusion:CABC is a rarely low-grade malignant cervical tumor with a good prognosis and rare metastasis.The overall prognosis of the tumor depends on the other tumor types involved.