乳腺浸润性导管癌孤立性宫颈转移1例并文献复习  

Isolated Cervical Metastasis of Invasive Ductal Carcinoma of Breast: a Case Report and Literature Review

作　　者：王琴 何明[1] 胡俊波[1] 闵晓红 高霞[1] 郭鹏[1] 胡顺则 刘涵瀚 张艳丽 WANG Qin;HE Mi rig;HU Junbo;MIN Xiaohong;GAO Xia;GUO Peng;HU Shunze;LIU Hanhan;ZHANG Yanli(Department of Pathology,Maternal and Child Health Hospital of Hubei Province,Wuhan Hubei 430070,China)

机构地区：[1]湖北省妇幼保健院病理科

出　　处：《华南国防医学杂志》2019年第11期741-743,747,共4页Military Medical Journal of South China

基　　金：湖北省科技厅面上项目(ZRMS2017001358)

摘　　要：目的探讨乳腺浸润性导管癌(invasive ductal carcinoma,IDC)孤立性宫颈转移的临床病理特点、免疫表型及鉴别诊断。方法对1例乳腺浸润性导管癌孤立性宫颈转移病例进行临床病理分析及免疫组织化学研究,并进行文献复习。结果大体检查:全子宫大小为11 cm×9 cm×4.5 cm,宫颈管长4 cm,宫深约4.5 cm,肌壁厚3.5 cm,宫内膜厚0.5 cm;子宫颈外口3 cm×2.5 cm;子宫肌壁间可见一枚灰白结节,直径0.5 cm。左侧输卵管长5 cm,直径0.5 cm,伞端开放;左侧卵巢大小3 cm×1.5 cm×0.5 cm,右侧输卵管长7 cm,上附囊肿一枚,大小4.5 cm×3 cm×3 cm,内含淡黄色清亮液体,伞端开放;右侧卵巢大小3.5 cm×1.5 cm×0.5 cm。镜下,宫颈间质可见一0.9 cm×0.4 cm的肿块,异形细胞在间质中浸润性生长,细胞核浆比增高,核深染,部分细胞胞浆红,周围宫颈未见宫颈上皮内病变(cervical intraepithelial neoplasia,CIN)及原位腺癌病灶。免疫表型:CK7(+),EMA(+),GATA3(+),GCDFP15(+),Mammaglobin(+),E-cadherin(+),Her-2(弱+),ER(+),PR(局灶+),P16(-),P63(-),P40(-),PAX8(-),P53(-),Ki67LI(约10%),CD31及肿瘤细胞D2-40示脉管内可见瘤栓。术后发射型计算机断层成像(emission computed tomography,ECT)扫描发现骨转移。结论非生殖道肿瘤转移至宫颈较罕见,诊断主要依据临床病史、病理学形态和免疫组织化学,需要与宫颈原发低分化腺癌、宫颈消化道转移性腺癌、低分化子宫内膜样腺癌等相鉴别。Objective To explore the clinicopathological features, immunophenotype and differential diagnosis of isolated cervical metastasis of invasive ductal carcinoma(IDC) of breast. Methods One case of isolated cervical metastasis from breast IDC was studied by clinicopathological and immunohistochemical methods, and the literatures were reviewed. Results General examination showed that the size of the whole uterus was 11 cm×9 cm×4.5 cm, the length of cervical canal was 4 cm, the depth of uterus was 4.5 cm, the thickness of muscle wall was 3.5 cm, the thickness of endometrium was 0.5 cm, the external cervix was 3 cm×2.5 cm, and a gray-white nodule was visible between the uterine muscular walls with a diameter of 0.5 cm. The length of left oviduct was 5 cm, the diameter was 0.5 cm, and the umbrella end was open. The size of left ovary was 3 cm×1.5 cm×0.5 cm, the length of right oviduct was 7 cm and one cyst was attached, with a size of 4.5 cm×3 cm×3 cm, which contained light yellow clear liquid and the umbrella end was open.The size of right ovary was 3.5 cm×1.5 cm×0.5 cm. The microscop showed that in the cervical stroma a lump of 0.9 cm×0.4 cm was seen. The heteromorphic cells grew infiltratly was observed in the stroma. The ratio of nucleus to cytoplasm was increased, the nucleus was hyperchromatic, some cell cytoplasm were red. The cervical intraepithelial neoplasia(CIN) and adenocarcinoma in situ were not found in the surrounding cervix. The immunophenotypes were CK7(+), EMA(+), GATA3(+), GCDFP15(+), Mammaglobin(+), E-cadherin(+), Her-2(weak +), ER(+), PR(focal +), P16(-), P63(-), P40(-), PAX8(-), P53(-), Ki67 LI(about 10%), CD31 and D2-40 showed intravascular tumor thrombus.After operation,bone metastases were found by emission computed tomography(ECT) examination. Conclusion Non-genital tract tumors metastasis to cervix is very rare. The diagnosis is mainly based on clinical history, pathological morphology and immunohistochemistry. It needs to be differentiated from primary poorly differentiated adenocar

关 键 词：乳腺浸润性导管癌 宫颈转移 免疫组织化学 鉴别诊断 

分 类 号：R736.1[医药卫生—肿瘤]