子宫颈原发性透明细胞癌16例临床病理分析  

Primary clear cell adenocarcinoma of the cervix:a clinicopathological analysis of 16 cases

作　　者：赵晓延 张瑶[1,2] 乔佳欣 任志敏 李文才[3] 李新敏 ZHAO Xiao-yan;ZHANG Yao;QIAO Jia-xin;REN Zhi-min;LI Wen-cai;LI Xin-min(Department of Pathology,Zhengzhou Maternal and Child Health Hospital,Zhengzhou 450012,China;Key laboratory of Cervical Cancer Prevention and Control in Henan Province,Zhengzhou 450012,China;Department of Pathology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州市妇幼保健院病理科,郑州450012 [2]河南省宫颈癌防治医学重点实验室,郑州450012 [3]郑州大学第一附属医院病理科,郑州450052

出　　处：《诊断病理学杂志》2025年第3期272-276,共5页Chinese Journal of Diagnostic Pathology

基　　金：河南省医学科技攻关计划项目(LHGJ20230763,LHGJ20220883);郑州市引进外国专家项目(ZZG2S2023001);郑州市科技惠民计划项目(2023KJHM0004)。

摘　　要：目的探讨子宫颈原发性透明细胞癌(PCCAC)的临床病理学特征,为临床PCCAC病理诊断、治疗及预后提供参考。方法回顾性分析16例PCCAC的临床病理学、影像学、实验室检查及免疫表型特征等。结果患者年龄9~77岁,平均年龄49岁。临床表现:13例为接触性出血或者阴道异常出血,1例为阴道褐色分泌物伴异味,1例为下腹痛,1例无明显症状。眼观:10例子宫颈或者宫颈内口可见明显肿物,3例子宫颈外口糜烂,3例未见明显病灶。镜检:低倍镜观,肿瘤细胞呈乳头状、腺管状、管囊状或实性生长;高倍镜观,肿瘤细胞为透明细胞或扁平细胞,细胞核有多形性,可见核仁,伴有丰富的透明胞质,细胞边缘清楚,部分细胞为鞋钉样细胞。肿瘤间质为纤维性间质,内有较多淋巴细胞及浆细胞浸润。免疫表型:癌细胞中p16(9/10)、NapsinA(7/9)阳性或灶状阳性,PAX-8(9/9)、HNF-1β(12/12)、CK7(7/7)均阳性,16例ER、PR、CD10、CEA均阴性,Ki-67增殖指数5%~70%,平均增殖指数31.88%。HPV检测:1例阳性,15例阴性。结论PCCAC是一种罕见的子宫颈恶性肿瘤,临床表现无明显特异性,与HPV感染无显著相关性;其诊断主要依靠病理组织学形态,需要注意与子宫颈中肾腺癌及转移性癌相鉴别,免疫表型分析有助于诊断及鉴别诊断。Objective To explore the clinicopathological characteristics,and to help for diagnosis,treatment and prognosis of primary clear cell adenocarcinoma of the cervix(PCCAC).Methods A retrospective analysis was conducted in 16 cases of PCCAC to study their clinical pathology,imaging,laboratory examination,and immune phenotype characteristics.Results The patients aged from 9 to 77 years,with averaged age 49 years.The clinical symptoms were contact bleeding or vaginal abnormal bleeding in 13 cases,with brown vaginal discharge with foul smell in 1 case,lower abdomen pain in 1 case.There were no obvious symptoms in 1 case.10 cases had obvious swelling on the cervix or internal cervical mass,3 cases had cervical erosion,and 3 cases had no obvious lesions.Microscopically,tumour cells grew in papillary,glandular tubes,tubular cystic or solid.Under high magnification,tumor cells were clear cells or flat cells.The nucleus was polymorphic.Nucleolus could be seen,with abundant transparent cytoplasm.The cell edges were clear,some of the cells were shoe-spike-like.The tumor interstitium was fibrous.There were more lymphocytic and plasma cell infiltration.p16(9/10),NapsinA(7/9)in cancer cells were all positive or partially positive.PAX-8(9/9),HNF-1β(12/12),CK7(7/7)in cancer cells were all positive.ER,PR,CD10,CEA of 16 cases were all negative.The proliferative index of Ki-67 was 5%-70%,with average 31.88%.1 case was positive and 15 cases were negative in HPV test.Conclusion PCCAC is a rare malignancy of the cervix.There is no obvious specificity in clinical presentation,and no significant association with HPV infection.Diagnosis of PCCAC is based on histopathological morphology.Attention should be paid to distinguish it from renal carcinoma in the cervix and metastatic carcinoma of the cervix.Immunophenotyping is helpful in the diagnosis and differential diagnosis.

关 键 词：子宫颈 透明细胞癌 临床病理 免疫表型 诊断 

分 类 号：R737.3[医药卫生—肿瘤]