伴生殖细胞肿瘤成分的子宫腺癌的临床病理研究  

Uterine adenocarcinoma with differentiation of germ cell tumors: A clinicopathological study

作　　者：马亚琪[1] 孟刚[1] 刘爱军[1] 王利群[1] 王昀[1] MA Ya-qi;MENG Gang;LIU Ai-jun;WANG Li-qun;WANG Yun(Department of Pathology, General Hospital of PLA, Beijing 100853, China)

机构地区：[1]中国人民解放军总医院病理科,北京100853

出　　处：《诊断病理学杂志》2018年第5期325-329,共5页Chinese Journal of Diagnostic Pathology

基　　金：解放军总医院临床扶持基金(编号:2015FC-TSYS-1025)

摘　　要：目的探讨伴有生殖细胞肿瘤成分的子宫腺癌的临床病理特点、治疗及预后。方法收集2例子宫腺癌伴生殖细胞肿瘤成分分化的病例,1例为高级别子宫内膜癌伴卵黄囊瘤分化,1例为宫颈腺癌复发后出现卵黄囊瘤及少许绒毛膜上皮癌分化。复习2例患者详细的临床资料,观察其组织学及免疫组化特点,并查阅相关文献进行分析总结。结果伴生殖细胞肿瘤分化的子宫腺癌,组织病理学上主要表现为明确的腺癌区及生殖细胞肿瘤分化区。腺癌区:肿瘤细胞呈典型的腺样或条索状生长;免疫组化显示肿瘤细胞CK、CK7、EMA、PAX8(+)。生殖细胞肿瘤分化区(卵黄囊瘤或绒毛膜上皮癌分化):肿瘤细胞呈微囊性、假腺样、实性巢片状生长,细胞异型性明显,部分区域可见S-D小体,肿瘤细胞周围可见出血、坏死;免疫组化显示肿瘤细胞AFP、SALL4、h CG、PLAP及OCT-4等(+)。该类疾病主要发生于绝经后妇女,临床表现为阴道异常出血,并常伴有血h CG和(或)AFP水平的升高。结论子宫腺癌伴发生殖细胞肿瘤分化可能属于一种去分化现象,在病理诊断上易漏诊、误诊。本病侵袭性强,预后差,临床多采取手术切除治疗,对放、化疗反应不敏感,多于术后2年内死亡。Objective To investigate the clinicopathological features,treatment and prognosis of uterine adenocarcinoma with differentiation of germ cell tumors. Methods Two cases of uterine adenocarcinoma with differentiation of germ cell tumors were collected,one high grade endometrial carcinoma with yolk sac tumor differentiation and another cervical adenocarcinoma recurrence after yolk sac tumor with little chorioepithelioma differentiation. The detailed clinical data of two patients were reviewed,and the characteristics of histology and immunohistochemistry were observed,then the related literature was reviewed and summarized. Results Adenocarcinoma with germ cell tumor differentiation was mainly manifested in the clear region of adenocarcinoma and the differentiation area of germ cell tumor. In the adenocarcinoma area,tumor cells showed typical adenoid or stripe like growth; Immunohistochemical staining showed the positive CK,CK7,EMA and PAX8 in tumor cells. In the differentiation area of germ cell tumor（ yolk sac tumor or choriocarcinoma differentiation）,The tumor cells were microcystic,pseudo adenoid,and solid nested growth. The cells were markedly dysplastic. S-D bodies were seen in some areas. Besides,hemorrhage and necrosis were seen around the tumor cells.Immunohistochemical staining showed that the tumor cells were positive for germ cell tumor markers,such as AFP,SALL4,h CG,PLAP and OCT-4. This kind of disease mainly occured in postmenopausal women with abnormal vaginal bleeding and often accompanied by a rise in blood h CG and/or AFP levels. Conclusion Uterine adenocarcinoma associated with germ cell tumor differentiation may belong to a kind of dedifferentiation,and often missed diagnosis and misdiagnosis in pathological diagnosis. The disease has a strong invasion and poor prognosis. Surgical resection is often used in clinical practice. It is insensitive to radiotherapy and chemotherapy. The patient often dies within 2 years after the operation.

关 键 词：子宫腺癌 宫颈腺癌 生殖细胞肿瘤 卵黄囊瘤 绒毛膜上皮癌 免疫组化 

分 类 号：R737.3[医药卫生—肿瘤]