宫颈小细胞癌20例临床病理分析  

Cervical small cell carcinoma: a clinicopathologic study of 20 cases

作　　者：梁国栋[1] 马亚琪[2] 宋欣[2] 陈薇[2] 王昀[2] 刘爱军[2] 

机构地区：[1]呼伦贝尔市人民医院病理科 [2]解放军总医院病理科,北京100853

出　　处：《诊断病理学杂志》2015年第1期8-11,共4页Chinese Journal of Diagnostic Pathology

基　　金：解放军总医院临床扶持基金(2013FC-TSYS-1025);解放军总医院科技创新基金(13KMM42)

摘　　要：目的探讨宫颈小细胞癌的临床病理特征及免疫组化表达特点。方法收集20例宫颈小细胞癌的临床资料,同时进行组织病理学观察及Cg A、Syn、CD56、ER、PR、p16、CK、p63、CK5、TTF-1和Ki-67的免疫组化检测。结果20例患者发病时平均年龄48岁（24～63岁）,临床表现为不规则阴道出血。组织学上,肿瘤细胞为圆形或短梭形,细胞体积较小,胞质少而不明显,核染色深,核仁不明显,核分裂象多见。其中3例合并鳞状细胞癌成分,2例合并腺癌成分。免疫组化示神经内分泌标记物阳性率由高到低依次为Syn（90%,18/20）、CD56（84.2%,16/19）、Cg A（52.9%,9/17）;三者全部阳性者35.3%（6/17）,至少2项阳性者41.2%（7/17）,至少1项阳性者100%;另外,广谱CK、TTF-1和p16的阳性率分别为76.9%（10/13）、35.3%（6/17）和44.4%（4/9）;ER和PR阳性率分别22.2%（2/9）和33.3%（3/9）;p63、CK5在小细胞癌中均为（-）;Ki-67阳性指数2例为25%～50%,18例〉50%。结论宫颈小细胞癌具有独特的组织学和免疫组化特点。免疫组化染色在肿瘤的诊断与鉴别诊断有重要价值,联合检测可提高诊断准确率。TTF-1在宫颈小细胞癌中弥漫（＋）较常见,不能作为特异性标记物。Objective To invsetigate the clinicpathological and immunohistochemical characteristics of small cell carcinoma of the uterine cervix. Methods Twenty cases of small cell carcinoma of cervix were collected,and analyzed with microscopic observation and immunohistochemical staining for Cg A,Syn,CD56,ER,PR,p16,CK,p63,CK5,TTF-1 and Ki-67. Results The average age was 48 years,ranged from 24 to 63 years old. Blood spotting or abnormal vaginal bleeding was the most common clinical manifestation. Histologically,the neoplastic cells appeared small,round in solid sheets with scant cytoplasm,hyperchchromatic nuclei and absence of nucleoli. Numerous mitotic figures were common findings. Three cases were associated with squamous cell carcinoma and two with adenocarcinoma. Immunohistochemical studies showed positive rate for Cg A,Syn and CD56 was 52. 9%（ 9 /17）,90%（ 18 /20） and CD56 84. 2%（ 16 /19）,respectively,and 35. 3% cases were positive for all three above markers,41. 2% for two of three markers,and 100% for at least one of the above three markers. Additionally,positive rate for TTF-1,pan-CK and p16 was 35. 3%（ 6 /17）,76. 9%（ 10 /13） and 44. 4%（ 4 /9）,respectively; and the positive rate for ER and PR was 22. 2% and 33. 3%,respectively. None was positive for p63 or CK5 in small cell carcinoma. Ki-67 index was 25%- 50% in 2 cases. Ki-67 index exceeded 50% in 18 cases. Conclusions Small cell carcinoma of uterine cervix is a highly malignant tumor with distinct morphology. Immunohistochemistry is useful in diagnosis and differentiated diagnosis. At least one neuroendocrine marker is positive. TTF-1 positivity is common in cervical small cell carcinoma and can not be regarded as a specific marker for primary or metastatic tumor.

关 键 词：宫颈 神经内分泌癌 小细胞癌 免疫组化 鉴别诊断 

分 类 号：R737.33[医药卫生—肿瘤]