宫颈毛玻璃细胞癌五例临床病理分析  

Glassy cell carcinoma of cervix： a clinicopathologic analysis of 5 cases

作　　者：朱慧庭[1] 李淑霞[1] 

机构地区：[1]同济大学附属第一妇婴保健院病理科,上海200040

出　　处：《中华病理学杂志》2011年第8期523-527,共5页Chinese Journal of Pathology

摘　　要：目的探讨宫颈毛玻璃细胞癌的临床病理特征、免疫组织化学特点、诊断和预后。方法回顾性分析了5例宫颈毛玻璃细胞癌的临床特征、脱落细胞学和组织病理学诊断要点及免疫组织化学特点。对照组为非特殊类型宫颈腺鳞癌10例、腺癌10例、鳞状细胞癌20例（角化型和非角化型各10例），非肿瘤性宫颈5例。结果5例宫颈毛玻璃细胞癌患者平均年龄34．4岁（31～41岁），症状有阴道流血或流水样白带，其中合并中期妊娠1例，服用避孕药史7年1例，临床检查均可见宫颈明显肿块。两例典型病例的形态学特点显示：细胞呈簇状、小片状分布，细胞界限清楚，肿瘤细胞呈典型毛玻璃样特点，胞质丰富，内含大量嗜酸性颗粒，核膜薄，核染色质相对细腻，核仁嗜酸性，较大且突出，核分裂象和凋亡易见，间质中可见大量嗜酸性粒细胞和浆细胞浸润。与其他宫颈癌相比，毛玻璃细胞癌Ki-67阳性指数高（≥70％），既表达鳞癌的标志物p63和CK34βE12，又表达腺癌的标志物CAM5．2、MUCl、MUC2和癌胚抗原。治疗均采取广泛全子宫切除术＋盆腔淋巴结清扫术＋术后辅助放疗或化疗，术后无瘤生存时间25d～33个月。结论宫颈毛玻璃细胞癌是腺鳞癌的特殊亚型，细胞学和组织学方面具有独特的形态特点，表达腺上皮及鳞状上皮标志物，增殖活性高。Objective To investigate the clinicopathological characteristics, histological diagnosis, immunohistochemistry and prognosis of cervical glassy cell carcinoma （GCC）. Methods The clinical characteristics, cytology, histology and immunohistochemistry were analyzed in 5 cases of GCC. Results The average age of the five patients was 34. 4 years （31 -41 years）. Abnormal vaginal bleeding and/or watery discharge were clinical presentations. One case was complicated with pregnancy and another one had a seven-year history of using contraceptives. All patients had an obvious mass in the cervix. Characteristic morphological features of GCC were present in 2 cases. Morphologically, the tumors consisted of clusters of tumor cells with distinct cell bounders, a large amount of eosinophilic granules in the cytoplasm imparting ground glass appearance, and thin nuclear membrane and prominent nucleoli. Nuclear enlargement and muhinucleation were frequently noted. Mitosis and apoptosis were common. Numerous eosinophils and plasma cells were present in the stroma. Immunohistochemically, GCC expressed markers for both squamous cell carcinoma （1363 and CK34βE12） and adenocarcinoma （ CAM5.2, MUC1, MUC2 and CEA）. Ki-67 proliferation index was high（ ≥70% ）. All the five patients were treated with radical hysterectomy, followed by radiation and chemotherapy. The tumor-free survival time ranged from 25 days to 33 months. Conclusions GCC is a distinct variant of adenosquamous carcinoma of the cervix with high proliferation index and expression of markers of both squamous cell carcinoma and adenocarcinoma. The tumor has characteristic cytological and histological features.

关 键 词：宫颈肿瘤 病理学 临床 细胞学 免疫组织化学 

分 类 号：R737.33[医药卫生—肿瘤]