子宫颈浸润性复层产黏液的癌临床与病理分析(附12例)  

Clinical and pathological analysis of invasive stratified mucin-producing carcinoma of the cervix(12 cases)

作　　者：吴倩文 阳琼芝 肖诗维 胡敏[1] 徐鹏飞 王满香[1] 樊利芳 岳君秋[1] 郭芳[1] WU Qianwen;YANG Qiongzhi;XIAO Shiwei;HU Min;XU Pengfei;WANG Manxiang;FAN Lifang;YUE Junqiu;GUO Fang(Hubei Cancer Hospital,Hubei Wuhan 430070,China)

机构地区：[1]湖北省肿瘤医院,湖北武汉430070

出　　处：《现代肿瘤医学》2024年第3期535-540,共6页Journal of Modern Oncology

基　　金：湖北省武汉市中青年医学骨干人才培养工程项目[编号:武卫生计生(2017)51号]。

摘　　要：目的:探讨子宫颈浸润性复层产黏液的癌(ISMC)临床病理学特征、诊断、鉴别诊断及治疗预后。方法:收集我院近3年诊断的子宫颈ISMC 12例,整理及分析其临床病理及随访资料并复习相关文献。结果:12例患者发病年龄为(51.1±7.4)岁,9例(75%)以阴道出血为主要症状,临床分期9例(75%)为Ib2期,2例(17%)为Ib3期,1例(8%)为Ⅲc2期;11例患者均在术后补充放、化疗,其中10例(91%)无复发,1例伴双肺多发转移;肿物最大径(32.4±5.5)mm;8例(67%)形成糜烂及结节状肿物,4例(33%)呈息肉样;镜下均可见典型的浸润性复层、实性、含黏液的癌细胞巢,巢周细胞呈栅栏状排列,除3例(25%)为纯的ISMC外,9例(75%)均合并其他类型的浸润性癌;12例(100%)查见宫颈上皮原位病变,包括子宫颈复层产黏液的上皮内病变、鳞状上皮内病变和原位腺癌;免疫表型ISMC表达腺上皮标记物,过碘酸酸酶/阿利新蓝染色(PAS/AB)染色阳性;10例行人乳头瘤病毒(HPV)检测,6例(50%)为18型,4例(33%)为16型。结论:ISMC具有独特的病理学特征,本文报道病例平均年龄偏大,临床分期偏早,虽然存在脉管癌栓,但随访至撰稿前仅1例发现转移,本文数据可为临床对该肿瘤的认识提供参考和补充。Objective:To investigate the clinicopathological features,diagnosis,differential diagnosis and prognosis of invasive stratified mucin-producing carcinoma(ISMC)of cervical carcinoma.Methods:12 cases of cervical ISMC diagnosed in our hospital in the past 3 years were collected.The clinicopathological and follow-up data were analyzed,and the relevant literature was reviewed.Results:The age of onset of 12 patients was(51.1±7.4)years old.9 patients(75%)had vaginal bleeding as the main symptom.9 patients(75%)had stage Ib2.2 patients(17%)had stage Ib3.1 patient(8%)had stage IIIc2.All the 11 patients received postoperative chemoradiotherapy,among which 10 patients(91%)had no recurrence and 1 patient had multiple metastases in both lungs.The maximum diameter of the mass was(32.4±5.5)mm.Erosion and nodular mass were found in 8 cases(67%),and polyp was found in 4 cases(33%).Microscopically,typical infiltrating multilayered,solid,mucus-containing cancer cells were seen,and the peri-nest cells were arranged in a palisade pattern.Except for 3(25%)pure ISMCs,9(75%)were complicated with other types of invasive cancer.In 12 cases(100%),cervical epithelial lesions were found in situ,including intraepithelial lesions of cervical multilayer mucous production,CIN and AIS.Immunophenotype ISMC expressed glandular epithelial markers,and PAS/AB staining was positive.In 12 cases,6(50%)were HPV type 18 and 4(33%)were HPV type 16.Conclusion:ISMC has unique pathological features.The average age of the reported cases is older and the clinical stage is early.Despite the presence of vascular cancer thrombus,only 1 case of metastasis was found during follow-up so far.

关 键 词：宫颈腺癌 人乳头瘤病毒感染相关性腺癌 浸润性复层产黏液的癌 复层产黏液的癌 

分 类 号：R737.33[医药卫生—肿瘤]