子宫颈小细胞癌细胞学与组织病理学特征及预后分析  

Cytological and histopathological characteristics and prognosis of small cell carcinoma of cervix

作　　者：李琦 郭琦 邹亮[1] 刘艳华 夏丽娜 于晓红[1] LI Qi;GUO Qi;ZOU Liang;LIU Yan-hua;XIA Li-na;YU Xiao-hong(Deparment of Pathology,Jiangxi Maternal and Child Health Hospital,Nanchang 330006,China)

机构地区：[1]江西省妇幼保健院病理科,南昌330006

出　　处：《诊断病理学杂志》2022年第2期123-127,131,共6页Chinese Journal of Diagnostic Pathology

摘　　要：目的 探讨子宫颈小细胞癌(SCCC)的临床病理学特征。方法 回顾性分析38例SCCC患者的临床病理资料、细胞学与组织学特征及预后,并复习相关文献。结果 38例SCCC患者年龄26~66岁,平均45.1岁,26例(68.4%)有阴道出血症状。38例中20例行子宫颈液基细胞学检查,细胞学诊断为鳞状上皮异常(ASCUS/ASC-H/HSIL)8例(40.0%),诊断为腺上皮异常(AGC/AGC-N)7例(35.0%),诊断为恶性细胞/异型小细胞4例(20.0%),诊断为阴性(NILM)1例(5.0%)。组织切片见SCCC合并腺癌13例,合并鳞癌3例,合并CIN3 3例。单纯型和混合型SCCC各占50%(19/38),混合型中多合并腺癌,占68.4%(13/19)。SCCC肿瘤细胞小而一致,镶嵌状排列,核呈圆形或梭形、深染,胞质缺乏,染色质呈细颗粒状,核仁不明显。免疫组化显示神经内分泌标志物Syn、CgA、CD56、PGP 9.5阳性率依次为94.7%、76.3%、86.5%、80.6%。34例随访时间6~72个月,至2020-12,21例死亡,总生存率38.2%。Log-rank检验显示临床分期、脉管侵犯和淋巴结转移与患者预后相关(P<0.05);Cox回归多因素生存分析显示临床分期是影响患者预后的独立危险因素(P<0.05)。结论 SCCC具有特征性的细胞﹑组织学形态改变,免疫组化在肿瘤的诊断与鉴别诊断有一定价值,临床分期、脉管侵犯和淋巴结转移与患者预后相关。Objective To investigate the clinicopathological features of small cell carcinoma of cervix(SCCC).Methods Clinicopathological data and follow-up result were analyzed in 38 cases of SCCCs and the relevant literatures were reviewed.Results The average age of 38 patients with SCCC was 45.1 years(26-66 years).26 patients(68.4%) had the symptoms of vaginal bleeding.Among the 38 cases,20 cases underwent cervical liquid based cytological detection:8 cases(40.0%) were diagnosed as squamous epithelial abnormality(ASCUS/ASC-H/HSIL),7 cases(35.0%) were diagnosed as glandular epithelial abnormality(AGC/AGC-N),4 cases(20.0%) were diagnosed as malignant cells/atypical small cells,and 1 case(5.0%) was diagnosed as normal(NILM).In 38 cases of SCCC,both pure SCCC and mixed SCCC accounted for 50%(19/38).The number of mixed SCCC combined with adenocarcinoma,squamous cell carcinoma,and CIN3 was 13,3 and 3 cases respectively.Adenocarcinoma accounted for the majority of mixed cases(13/19,68.4%).The tumor cells of SCCC were small and uniform,in mosaic arrangement,with round or fusiform nucleus,deep staining and lack of cytoplasm;chromatin was granular and nucleolus was not obvious.The positive rates of Syn,CgA,CD56 and PGP9.5 were 94.7%,76.3%,86.5% and 80.6%,respectively.34 cases were followed up for 6-72 months.By December 2020,21 cases died.The overall survival rate was 38.2%.Log-rank test showed that clinical stage,vascular invasion and lymph node metastasis were associated with prognosis(P<0.05).Cox regression multivariate survival analysis showed that clinical stage was an independent risk factor for prognosis(P<0.05).Conclusion SCCC has characteristic cytopathological and histopathological features.Immunohistochemistry is valuable in the diagnosis and differential diagnosis.Clinical stage,vascular invasion and lymph node metastasis are related to the prognosis of patients.

关 键 词：子宫颈小细胞癌 细胞学 组织病理学 免疫组化 预后 

分 类 号：R36[医药卫生—病理学]