宫颈浸润性复层产黏液性癌18例HER2扩增与PD-L1表达

HER2 amplification and PD-L1 expression in invasive stratified mucin-producing carcinoma of the cervix:a clinicopathological analysis of eighteen cases

目的探讨宫颈浸润性复层产黏液性癌(invasive stratified mucin-producing carcinoma,ISMC)的临床病理特征、预后及HER2、PD-L1的表达情况。方法收集陆军军医大学陆军特色医学中心(大坪医院)2018年1月至2023年12月诊治的18例根治性宫颈ISMC患者的临床病理资料并对其进行分析,同时进行了PD-L1、HER2免疫组织化学染色及荧光原位杂交(FISH)HER2检测。结果患者年龄31~72岁,平均45岁;约占我院同期宫颈腺癌的8%;11例为纯ISMC,7例为混合型,混合成分为鳞状细胞癌及普通型腺癌;1例合并小细胞神经内分泌癌;活检明确诊断3例(3/18);浸润模式Silva B型5例,C型13例;3例出现区域淋巴结转移;13例患者无病生存,1例合并小细胞神经内分泌癌的患者发生远处转移;15例(15/18)PD-L1综合阳性评分≥1,7例(7/18)PD-L1肿瘤细胞阳性比例分数≥1%;1例HER23+和1例HER22+,均为FISH扩增阳性;2例HER21+,14例HER20。结论宫颈ISMC罕见,形态学谱系广泛,可与其他类型的宫颈癌混合存在,活检诊断准确率极低;PD-L1在大部分ISMC病例中呈阳性表达,HER2在少数病例中过表达及低表达,有望尝试针对PD-L1的免疫治疗及HER2的靶向治疗。

ObjectiveTo investigate the clinicopathological features,prognosis and the expression of HER2 and PD-L1 in invasive stratified mucin-producing carcinoma of the cervix(ISMC).MethodsThe clinicopathological data of 18 ISMC cases with radical resection of the cervix diagnosed in the Daping Hospital,Army Medical University from January 2018 to December 2023 were collected and retrospectively analyzed.PD-L1 and HER2 immunohistochemical staining and HER2 FISH were conducted.ResultsThe patient ages ranged from 31 to 72 years,with an average of 45 years.Approximately 8%of cervical adenocarcinoma cases in our hospital during the same period.Eleven cases were pure ISMC,and 7 cases were mixed-type ISMC,with the component of squamous cell carcinoma or usual-type adenocarcinoma.One case showed concurrent small cell neuroendocrine carcinoma(SCNEC).Three cases were diagnosed through biopsy(3/18).Five cases were of Silva pattern B and 13 cases of Silva pattern C.Three cases showed regional lymph node metastasis.Thirteen patients were disease-free at the end of the follow-up,while the ISMC patient with concurrent SCNEC developed distant metastasis.Fifteen cases(15/18)had PD-L1 expression with CPS≥1,and 7 cases(7/18)had PD-L1 TPS≥1%.One case of HER23+and one case of HER22+were both positive for FISH amplification;two cases HER21+,14 cases HER20.ConclusionsCervical ISMC is rare,has a wide spectrum of morphology,and can coexist with other types of cervical cancer.PD-L1 is positive in most of the ISMC cases,while HER2 is amplified or lowly expressed in a small portion of them.Thus,it is possible to treat ISMC patients with therapies targeting PD-L1 and therapy targeting HER2.