子宫中肾样腺癌3例临床病理观察  

Mesonephric-like adenocarcinoma in uterus:a clinicopathological study of three cases

作　　者：张伟璇 李之玮 张伟 ZHANG Wei-xuan;LI Zhi-wei;ZHANG Wei(Department of Clinical Pathology,the First Affiliated Hospital of uterine Wannan Medical College/Yijishan Hospital,Wuhu 241004,China;Graduate School of Wannan Medical College,Wuhu 241002,China)

机构地区：[1]皖南医学院第一附属医院/弋矶山医院临床病理科,安徽芜湖241004 [2]皖南医学院研究生院,安徽芜湖241002

出　　处：《诊断病理学杂志》2025年第2期171-174,181,共5页Chinese Journal of Diagnostic Pathology

基　　金：皖南医学院第一附属医院(弋矶山医院)引进人才专项科研启动基金(YR202214);安徽省新时代育人质量工程项目(研究生教育)(2022zyxwjxalk158);皖南医学院弋矶山医院管理与服务创新项目(CX2023018)。

摘　　要：目的探讨子宫中肾样腺癌(MLA)的临床病理学特征、免疫表型及分子遗传学改变。方法收集3例MLA患者的临床资料,采用HE、免疫组织化学EnVision法染色、PCR技术进行检测,分析其临床病理特征并复习相关文献。结果3例患者平均年龄63岁。均表现为阴道不规则流血就诊。肿瘤最大直径约1.0~5.1 cm,切面灰白色,实性。镜下肿瘤细胞呈乳头状、腺管样、实性片状排列;部分管腔内含有淡红色浆液;细胞大小较为一致,胞质较少,淡嗜伊红,部分胞质透明,细胞核呈圆形或卵圆形,染色质深染,核膜不规则,可见核沟;部分区域间质内血管壁玻璃样变性。免疫表型:PAX2、PAX8、GATA3、TTF-1、CD10、Vimentin、MLH1、MSH2、MSH6、PMS2、CK7均阳性,其中CD10为腔缘阳性且显示子宫内膜间质缺失,GATA3、TTF-1、p16和CK7部分阳性;ER、PR、WT1均阴性,p53为野生型,Ki-67指数约70%。2例检测到KRAS基因突变,1例检测到PIK3CA基因突变。结论MLA属于罕见的妇科恶性肿瘤,具有较为独特的组织学、免疫表型和分子遗传学特征,临床上更具侵袭性,预后较差。Objective To investigate the clinicopathological features,immunophenotype and molecular genetic changes of mesonephric-like adenocarcinoma(MLA).Methods The clinical data of 3 MLA patients were collected and detected by HE stain,immunohistochemical EnVision staining and PCR.The clinicopathological features were analyzed and related literature was reviewed.Results The average age of the three patients was 63 years.All of them presented with irregular vaginal bleeding.The maximum diameter of the tumor was about 1.0~5.1 cm,and the section was gray and solid.Microscopically,the tumor cells showed a papillary,glandular,solid lamellar arrangements.Some lumen contained light red serous fluid;the cell size was consistent,with less cytoplasm,eosinophilic,partially transparent cytoplasm,round or oval nuclei,deeply stained chromatin,irregular nuclear membrane,and visible nuclear furrows.Hyaline degeneration of vascular walls in some interstitial regions was noted.Immunophenotypically,PAX2,PAX8,GATA3,TTF-1,CD10,vimentin,MLH1,MSH2,MSH6,PMS2,and CK7 were all positive,among which CD10 was positive for the lumen and endometrial stromal deletion,GATA3,TTF-1,p16,and CK7 were partially positive.ER,PR,WT1 were negative,p53 was wild type,and Ki-67 index was about 70%.KRAS gene mutation was detected in 2 cases and PIK3CA gene mutation in 1 case.Conclusion MLA is a rare gynecological malignant tumor with unique histological,immunophenotypic and molecular genetic features.It is more invasive and has a poor prognosis.

关 键 词：中肾样腺癌 临床 病理 免疫组化 分子遗传学 

分 类 号：R737.33[医药卫生—肿瘤]