非HPV相关型宫颈腺癌的临床病理特点及预后  

Clinicopathological features and prognosis of non-HPV-associated cervical adenocarcinoma

作　　者：王玄 孙莹莹 朱博[1,2,3] 俞岚[1,2,3] WANG Xuan;SUN Yingying;ZHU Bo;YU Lan(Department of Pathology,First Affiliated Hospital of Bengbu Medical College,Bengbu Anhui 233004;Department of Pathology,Bengbu Medical College,Bengbu Anhui 233004;Anhui Key Laboratory ofInfection and Immunity,Bengbu Medical College,Bengbu Anhui 233004,China)

机构地区：[1]蚌埠医学院第一附属医院病理科,安徽蚌埠233004 [2]蚌埠医学院病理学教研室,安徽蚌埠233004 [3]蚌埠医学院安徽省感染与免疫重点实验室,安徽蚌埠233004

出　　处：《临床与病理杂志》2023年第3期425-435,共11页Journal of Clinical and Pathological Research

基　　金：512人才培育计划(by51201308)。

摘　　要：目的:探讨非人乳头瘤病毒(human papillomavirus,HPV)相关型宫颈腺癌的临床病理学特征及预后。方法:回顾性分析40例非HPV相关型宫颈腺癌患者的临床病理学特征,总结不同病理分型的临床特征、病理形态、免疫组织化学染色结果,并分析患者预后。结果:患者平均年龄50(18~63)岁,均无HPV感染,临床特征多不明显,18例死亡,国际妇产科联合会(International Federation of Gynecology and Obstetrics,FIGO)分期以II期为主。治疗方法以手术切除为主,视情况辅以放化疗。大体多无明显肿块。光镜检查显示:宫颈胃型腺癌(gastric-type endocervical adenocarcinoma,GEA)由大小不一的不规则黏液腺体浸润;宫颈子宫内膜样腺癌(endometrial adenocarcinoma of cervix,UEA)具有UEA的特征,在排除UEA累及宫颈这种情况后可做出诊断;宫颈中肾管癌(mesonephric adenocarcinoma,MNA)呈不规则的腺管状或乳头状排列,核大小不一;宫颈透明细胞癌(clear cell carcinoma,CCC)镜下肿瘤主要由透明细胞、靴钉样细胞及柱状细胞按不同比例排列,呈管囊状、乳头状或固体状生长;腺癌非特指(adenocarcinoma is not specified,NOS)是指非HPV相关性宫颈腺癌不能被归类为上述类型,通常分化较差,可排列成实体样。免疫表型检测显示:癌胚抗原(carcinoembryonic antigen,CEA)、细胞角蛋白7(cytokeratin 7,CK7)均呈阳性,p53部分呈阴性,p16大部分呈阴性、部分呈斑驳阳性,GEA中黏蛋白6(mucin-6,MUC6)大部分呈阳性(18/21),UEA中雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、波形蛋白(vimentin)均呈阴性,MNA中配对盒基因8(paired box gene 8,PAX8)、钙网膜蛋白(calretinin)大部分呈阳性,CCC中napsin-A、肝细胞核因子1β(hepatocyte nuclear factor 1β,HNF-1β)、PAX8大部分呈阳性,USC中肾母细胞瘤基因(Wilm’s tumor gene,WT1)均呈阴性,Ki-67增殖指数多>50%。结论:非HPV相关型宫颈腺癌的发病率相对较低,但因其临床�Objective:To investigate the clinicopathological features and prognosis of non-human papillomavirus(HPV)associated cervical adenocarcinoma.Methods:The clinicopathological features of 40 patients with non-HPV-associated cervical adenocarcinoma were retrospectively analyzed,and the clinical features,pathological morphology and immunohistochemical staining results of different pathological types were summarized,and the prognosis of patients was analyzed.Results:The mean age of patients was 50(18−63)years,no HPV infection,clinical characteristics were not obvious,18 patients died,International Federation of Gynecology and Obstetrics(FIGO)stage II was the main stage.Surgical resection was the main treatment,supplemented by radiotherapy and chemotherapy depending on the situation.No obvious bump was observed in general.Microscopic examination showed that gastric carcinoma(GEA)was infiltrated by irregular mucus glands of varying sizes.Endometrial adenocarcinoma of cervix(UEA)was characterized by endometrial adenocarcinoma and could be diagnosed after excluding endometrial adenocarcinoma involving the cervix.Mesonephric adenocarcinoma(MNA)was an irregular,glandular or papillary arrangement with variously sized nuclei.Clear cell carcinoma(CCC)of the cervix was mainly composed of clear cells,spike-like cells,and columnar cells arranged in different proportion into tubular sac,papillary or solid growth.Adenocarcinoma non-specific(NOS)referred to a non-HPV-associated cervical adenocarcinoma that could not be classified as other types,and which was usually poorly differentiated and arranged in solid form.Immunophenotype showed that carcinoembryonic antigen(CEA)and cytokeratin 7(CK7)were positive,p53 was partially negative,p16 was mostly negative and partially mottled positive,mucin-6(MUC6)was mostly positive in GEA(18/21),estrogen receptor(ER),progesterone receptor(PR),and vimentin were all negative in UEA,paired box gene 8(PAX8)and calretinin were mostly positive in MNA,napsin-A,hepatocyte nuclear factor 1β(HNF-1β),and P

关 键 词：非HPV相关型宫颈腺癌 病理特点 临床特征 

分 类 号：R737.33[医药卫生—肿瘤]