子宫颈胃型腺癌11例临床分析  

A Clinical Analysis of 11 Cases of Gastric-type Endocervical Adenocarcinoma

作　　者：王登凤 张国楠 石宇 樊英 周凤智 宋水勤 余健 徐世强 刘红 Wang Dengfeng;Zhang Guonan;Shi Yu;Fan Ying;Zhou Fengzhi;Song Shuiqin;Yu Jian;Xu Shiqiang;Liu Hong(Gynecologic Oncology Center,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,School of Medicine,University of Electronic Science and Technology of China,Chengdu 610041,Sichuan,China)

机构地区：[1]四川省肿瘤医院·研究所,四川省癌症防治中心,电子科技大学医学院附属肿瘤医院妇科肿瘤中心,成都610041

出　　处：《肿瘤预防与治疗》2021年第5期431-437,共7页Journal of Cancer Control And Treatment

基　　金：四川省医学重点学科建设项目(编号:川卫办发[2007]407号)。

摘　　要：目的:探讨子宫颈胃型腺癌(gastric-type endocervical adenocarcinoma,G-EAC)的临床病理特征及预后.方法:收集2013年1月1日至2021年2月10日期间我院收治的G-EAC患者的临床病理资料、治疗情况,并进行预后随访.结果:共11例G-EAC患者,中位年龄50岁,1例(9.09%)Ⅰ期,3例(27.27%)Ⅱ期,2例(18.18%)Ⅲ期,4例Ⅳ期(36.36%),1例分期不详.卵巢是最常见的转移部位.G-EAC临床表现以囊性或囊实性的盆腔包块多见,其次为阴道流液、阴道不规则流血.子宫颈外观多光滑和/或肥大.7例行人乳头状瘤病毒(human papillomavirus,HPV)检测、均呈阴性,其中6例(85.71%)子宫颈细胞学检查未见异常;可伴有CA199、CA125等肿瘤标记物的异常升高.术后病理方面,7例中有4例(57.14%)存在肿瘤局部明显浸润;免疫组化表型有一定特异性.治疗方面,3例仅手术治疗,3例行放化疗,5例手术+放化疗.共8例患者完成随访,中位随访时间24.9个月,2例未复发,3例复发,3例死亡.结论:G-EAC是一种罕见的、高侵袭性的、非HPV相关型子宫颈腺癌,晚期比例高,临床表现不特异,且缺乏敏感肿瘤标记物,可酷似卵巢肿瘤表现,术前诊断困难,预后差,需引起临床医生和病理医生的重视,提高对该病的警惕性,充分的术前评估和术中探查,以及术后病理辅以相应免疫标记检查,可减少漏诊和误诊.Objective: To explore the clinic-pathological characteristics and prognosis of gastric-type endocervical adenocarcinoma(G-EAC). Methods: Clinic-pathological and treatment data of G-EAC patients admitted to our hospital between January 1 st, 2013 and February 10 th, 2021 were collected, and the prognosis was followed up. Results: Among the 11 cases of G-EAC(median age: 50 years), 1 case was in unknown stage, 1 case(9.09%) in stage Ⅰ, 3 cases(27.27%) in stage Ⅱ, 2 cases(18.18%) in stage Ⅲ, and 4 cases(36.36%) in stage Ⅳ. The most common metastatic site was ovary. The clinical manifestations were mainly cystic or cyst-solid pelvic masses, followed by vaginal fluid and irregular vaginal bleeding. The cervix showed normal appearance and/or hypertrophy in most patients. Seven patients underwent HPV test and all of them were HPV-negative. 85.71%(6/7) patients showed no abnormalities in Thinprep cytologic test. There might be abnormal increases in tumor markers such as CA199, CA125, etc. 57.14%(4/7) of the cases had obvious local invasion. The immunophenotypes were specific. 3 cases were treated only by surgery, 3 cases by chemoradiotherapy, and 5 cases by surgery plus chemoradiotherapy. 8 patients were followed up, with the median follow-up time of 24.9 months. 2 cases did not recur, 3 cases recurred, and 3 cases died. Conclusion: G-EAC is a rare, non-HPV-related, highly invasive cervical adenocarcinoma, usually with advanced stages, unspecific clinical manifestations, scarce sensitive tumor markers and poor prognosis. Its symptoms, signs, and auxiliary examination results may closely resemble ovarian tumor, making it difficult to be diagnosed before operation, which needs close attention and full understanding. Adequate preoperative evaluation, intraoperative exploration and postoperative pathology with corresponding immunohistochemical markers can reduce missed diagnosis and misdiagnosis.

关 键 词：子宫颈癌 胃型腺癌 临床特征 卵巢肿瘤 鉴别诊断 

分 类 号：R737.33[医药卫生—肿瘤] R711.74[医药卫生—临床医学]