女性生殖道具有中肾形态特征的腺癌七例临床病理分析  

Adenocarcinomas with mesonephric features in gynecologic tract: a clinicopathological analysis of seven cases

作　　者：梁云[1] 阮华娟 王文珊 余明华[1] 陈晓端[1] 张晓飞[1] Liang Yun;Ruan Huajuan;Wang Wenshan;Yu Minghua;Chen Xiaoduan;Zhang Xiaofei(Department of Pathology,the Women′s Hospital,School of Medicine,Zhejiang University,Hangzhou 310006,China;Department of Pathology,the First People′s Hospital of Hangzhou Lin′an District,Hangzhou 311311,China)

机构地区：[1]浙江大学医学院附属妇产科医院病理科,杭州310006 [2]浙江省杭州市临安区第一人民医院病理科,311311

出　　处：《中华病理学杂志》2021年第7期791-795,共5页Chinese Journal of Pathology

基　　金：浙江省自然科学基金(LY20H160029)。

摘　　要：目的探讨女性生殖道不同部位具有中肾形态特征的腺癌在组织形态、免疫表型等方面的异同。方法收集浙江大学医学院附属妇产科医院2018年1月至2020年10月间确诊的子宫颈中肾腺癌(MA)2例及子宫体、卵巢中肾样腺癌(MLA)5例,病变组织行HE染色、免疫组织化学染色及KRAS基因突变检测,并复习相关文献。结果子宫颈MA与子宫体、卵巢MLA有相同形态特征,表现为腺管、乳头、实性等多种结构的混合。然而2例子宫颈MA主体位于宫颈间质内,肿瘤周边存在中肾管残余,4例子宫体MLA主要累及子宫内膜及肌层,1例卵巢MLA可见局部子宫内膜异位,且MLA病例均未见中肾管残留。免疫组织化学GATA3在全部7例MA/MLA中表达,TTF1仅在4/5例MLA中表达。所有病例雌激素受体、孕激素受体阴性,p53野生型。所检测的5例MA/MLA病变均存在KRAS基因突变。在6~32个月的随访中,1例患者出现复发,其余均无瘤生存。结论女性生殖道子宫颈MA与子宫体、卵巢MLA有相似的形态特征、免疫表型,且均存在KRAS基因突变;但与子宫颈MA起源于中肾残余不同,后者与苗勒上皮关系密切。Objective To investigate and compare the histologic characteristics of adenocarcinomas with mesonephric features located in different parts of the gynecologic tract.Methods Two cases of mesonephric adenocarcinomas(MA)of the cervix and 5 cases of mesonephric-like adenocarcinomas(MLA)of the uterus and ovary were collected in Women′s Hospital,School of Medicine,Zhejiang University from January 2018 to October 2020.Hematoxylin-eosin staining,immunohistochemistry and KRAS mutation testing were performed together with review of literature.Results MA of the cervix as well as MLA of the uterus and ovary had similar morphologic features,showing an admixture of glandular,tubular,papillary and solid growth patterns.However,both MA cases were located in cervical stroma,which demonstrated residual mesonephric ducts present at the periphery.All four uterine MLA cases extensively involved the endometrium and myometrium.The ovarian MLA case was associated with endometriosis.No residual mesonephric ducts were present in the MLA cases.Immunohistochemically,GATA3 was positive in all seven MA/MLA cases.TTF1 was expressed only in 4/5 MLA cases.ER and PR were negative and p53 was wild-type in all cases.KRAS mutation was detected in all five cases.During the 6-32 months of follow-up,one patient developed recurrence and the others were tumor-free.Conclusions In the gynecologic tract,both MA in cervix and MLA in uterus and ovary have similar morphologic features,immunohistochemical expression and KRAS mutation.However,distinct from MA that originates from mesonephric remnant,MLA is closely related to Mullerian epithelium.

关 键 词：腺癌 子宫 卵巢 病理学 诊断 

分 类 号：R737.3[医药卫生—肿瘤]