p16及HPV分型检测在子宫颈黏液腺癌伴双侧卵巢转移中的诊断价值  

Values of p16 expression and HPV subtyping in mucinous adenocarcinoma of cervix metastatic to both ovaries

作　　者：沈扬眉[1] 何英[1] 徐炼[1] 魏晓霞[1] 赵霞[2] 

机构地区：[1]四川大学华西第二医院病理科,成都610041 [2]四川大学华西第二医院妇产科,成都610041

出　　处：《临床与实验病理学杂志》2014年第8期858-862,共5页Chinese Journal of Clinical and Experimental Pathology

基　　金：国家自然科学基金青年基金(81101992);四川省科技厅科技支撑项目(2012SZ0003)

摘　　要：目的探讨联合使用免疫组化标记p16及HPV分型检测在诊断和鉴别诊断子宫颈黏液腺癌伴双侧卵巢转移中的诊断价值。方法分析3例子宫颈黏液腺癌伴双侧卵巢转移的临床病理学特征,对子宫颈及卵巢的癌灶进行含p16在内的多个免疫组化标志物染色及HPV分型检测。结果 3例患者的子宫颈均有不同程度的肥大、糜烂及肿块,双侧卵巢增大,切面有黏液感伴出血、坏死;镜下可见子宫颈腺癌周围有不典型增生的子宫颈管腺上皮,与腺癌移行过渡,可见癌栓,腺癌几乎侵及子宫颈全层;双侧卵巢纤维增生明显,腺癌穿插其中。颈体交界、子宫内膜、输卵管黏膜、阴道手术切缘等查见癌累及。3例子宫颈及卵巢癌灶的免疫表型基本一致,均强阳性表达p16、CK7和Ki-67,HPV亚型分型检测阳性结果如下。子宫颈/卵巢:例1,16、18/16、18、58;例2,16、18/18;例3,16/18。根据p16的表达及HPV分型检测结果,提示3例均为子宫颈黏液腺癌伴双侧卵巢转移。结论子宫颈黏液腺癌伴双侧卵巢转移属于晚期子宫颈癌。借助p16的表达及HPV亚型的分型检测结果可诊断及鉴别诊断肿瘤的原发部位,有利于肿瘤的后期治疗。Purpose To study the value of pl6 and HPV subtyping in mucinous adenocarcinoma of cervix with metastasis to both ovaries. Methods The clinicopathological characteristics were analyzed in three cases of cervical mucinous adenocarcinoma, and immunohistoehemistry and HPV subtyping were used both in the lesions of cervix and ovary. Results Macroscopically, the cervixes of three cases showed hypertrophy, erosion and the masses. The cut surface of both ovary masses was mucous mixed with necrosis and hemorrhage. Microscopically, in cervix, the dysplastic glands and cancer embolus were accompanied with adenocarcinoma, which was infiltrated in almost the whole cervix. A metastatic background was shown in ovaries, and the adenocarcinoma was inserted in the hyperplastic fibrous stroma. The ad metastasized to everywhere, including transitional zone of the cervix, endometrium, the mucosa of tube and vagina, p16 was strongly expressed in both cervix and ovary. HPV subtyping in cervix/ovary was as follows. Case 1 ： types 16, 18/16, 18 and 58, case 2 ： types 16, 18/18, and case 3 ： type 16/18. According to the above results, the final diagnosis was mucinous adenocarcinoma of cervix with metastatic to both ovaries. Conclusions It is the late stage that mutinous adenocarcinoma of cervix metastasizes to both ovaries. With the help of the p16 expression and HPV subtyping, it is not difficult to identify the primary origin, which is helpful for the further treatment.

关 键 词：子宫颈肿瘤 卵巢肿瘤 黏液腺癌 P16 HPV分型 免疫组织化学 

分 类 号：R737.33[医药卫生—肿瘤] R737.31[医药卫生—临床医学]