子宫颈HPV相关性乳头状鳞状细胞癌的临床病理分析  

Clinical and pathological analysis of HPV associated papillary squamous cell carcinoma of the cervix

作　　者：戴林[1] 周世广 卢立军 姚元朴 井华 张雪 回允中[1,2] DAI Lin;ZHOU Shiguang;LU Lijun;YAO Yuanpu;JING Hua;ZHANG Xue;HUI Yunzhong(Departmen of Pathology,Peking University People’s Hospital,Beijing 100044,China;Department of Pathology,Beijing Wuzhou Women and Children’s Hospital,Beijing 100022,China)

机构地区：[1]北京大学人民医院病理科,北京100044 [2]北京五洲妇儿医院病理科,北京100022

出　　处：《临床与实验病理学杂志》2023年第8期953-956,962,共5页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的探讨子宫颈乳头状鳞状细胞癌(papillary squamous cell carcinoma,PSCC)的临床病理学特征、诊断及鉴别诊断。方法收集18例子宫颈PSCC临床资料,行HE和免疫组化染色,分析其临床病理特征,并复习相关文献。结果18例患者年龄30~71岁,平均49岁,镜下活检和手术标本均可见浅表乳头状结构,伴纤维血管轴心,被覆上皮具有子宫颈高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)的特征。17例子宫颈活检病理学检查均为典型的PSCC,1例子宫颈虽有菜花样肿物,但活检标本未见间质浸润,行子宫颈锥切,锥切标本仍未见间质浸润。13例行根治性子宫切除,最后均诊断为子宫颈PSCC,伴间质浸润;4例活检诊断后失访。免疫表型:p16呈弥漫强阳性(块状)染色,p63、CK7阳性,CK20阴性,Ki-67增殖指数>90%,遍布上皮全层。14例行HPV DNA分型检测,其中10例HPV 16阳性(71.4%),2例分别合并HPV 53和HPV 59感染。结论子宫颈PSCC具有典型的病理形态学表现,多数病例通过HE染色切片易于诊断;出现外生型浸润即可诊断PSCC,根据HPV DNA分型和(或)p16免疫组化染色可诊断是否与HPV相关。Purpose To exploring the clinical pathological characteristics,diagnosis,and differential diagnosis of papillary squamous cell carcinoma(PSCC)of the cervix.Methods Clinical data of 18 cases of cervical PSCC were collected.HE and immunohistochemical staining was performed to analyze its pathological features,and relevant literatures were reviewed.Results 18 patients aged 30-71 years,with an average age of 49 years.Microscopically,both biopsy and surgical specimens showed superficial papillary structures with fibrous vasculaRcores and lined with epithelium with features of high-grade squamous intraepithelial lesion(HSIL)of the cervix.Pathological examination of cervical biopsy showed typical PSCC in 17 cases.Although there was caulifloweRlike tumoRin one case,no interstitial infiltration was found in the biopsy sample and cervical conization was performed.No interstitial infiltration was found in the conization sample.Thirteen cases underwent radical hysterectomy,all of which were diagnosed as cervical PSCC with interstitial infiltration.FouRcases were lost afteRbiopsy diagnosis.Immunophenotype:p16 showed diffuse strong positive(block)reactions,with p63 and CK7 positive,CK20 negative,and Ki-67 proliferation index>90%,spreading throughout the entire epithelial layer.14 cases underwent HPV DNA typing,of which 10 cases were HPV 16 positive(71.4%),and 2 cases were complicated with HPV 53 and HPV 59 infections,respectively.Conclusion Cervical PSCC has typical histopathological manifestations,and most cases are easily diagnosed through HE staining sections.The appearance of exogenous infiltration can diagnose PSCC,and whetheRit is related to HPV can be diagnosed based on HPV DNA typing and/oRp16 immunohistochemistry staining.

关 键 词：子宫颈肿瘤 鳞状细胞癌 乳头状 HPV相关性 

分 类 号：R737.33[医药卫生—肿瘤]