直肠腺瘤样腺癌伴宫颈及阴道转移1例  

A case of adenoma-like adenocarcinoma with cervical and vaginal metastasis

作　　者：尹腊梅 刘富金[1] 王波[1] YIN Lamei;LIU Fujin;WANG Bo(Department of Pathology,Hainan General Hospital,Hainan Affiliated Hospital of Hainan Medical University,Haikou 570311,China)

机构地区：[1]海南省人民医院/海南医科大学附属海南医院病理科,海口570311

出　　处：《临床与病理杂志》2025年第1期116-121,共6页Journal of Clinical and Pathological Research

基　　金：海南省重大科技计划(ZDYF2021SHFZ247);海南省自然科学基金青年基金(820QN387)。

摘　　要：为探讨直肠腺瘤样腺癌的临床病理特征、免疫组织化学、诊断与鉴别诊断要点,本文报告1例老年女性患者,2022年因“大便带血伴肛门肿物脱出1年余”入住海南省人民医院。2022年和2024年分别送检宫颈及阴道肿物,观察其组织学形态及免疫表型特征,被诊断为转移性直肠腺瘤样腺癌。光镜下直肠、宫颈及阴道肿瘤组织形态上与绒毛状-管状腺瘤相似,均表现为异型腺上皮呈绒毛状生长,腺上皮轻度异型增生,瘤组织向下推挤性生长。肿瘤细胞尾型同源盒转录因子2(caudal-related homeobox transcription factor 2,CDX2)、特异AT序列结合蛋白2(specific AT sequence binding protein 2,SATB-2)为阳性,抑制基因蛋白16(suppressor gene protein 16,P16)阴性。腺瘤样腺癌是一种少见病,容易误诊为腺瘤,伴宫颈及阴道转移者更为少见,易与宫颈肿瘤相混淆,需密切结合临床病史及免疫表型以明确诊断。This study aims to explore the clinicopathological features,immunohistochemistry,and diagnostic and differential diagnostic key points of rectal adenoma-like adenocarcinoma.We report a case of an elderly female patient who was admitted to Hainan Provincial People’s Hospital in 2022 due to“bloody stool with prolapsed anal mass for over a year.”In 2022 and 2024,cervical and vaginal tumors were biopsied and sent for histological examination.The tumors were diagnosed as metastatic rectal adenoma-like adenocarcinoma.Histological and immunophenotypic features of rectal,cervical,and vaginal tumor tissues were observed.The tumors in all sites showed similar histological patterns to villous-tubular adenomas,with atypical glandular epithelium growing in a villous pattern and mild atypical hyperplasia of the epithelium.The tumor tissues exhibited pushing growth.Immunohistochemistry showed that tumor cells were positive for caudalrelated homeobox transcription factor(CDX2)and specific AT sequence binding protein 2(SATB-2),but negative for suppressor gene protein 16(P16).Adenoma-like adenocarcinoma is a rare disease,often misdiagnosed as an adenoma,and cases with cervical and vaginal metastasis are even rarer.It is easily confused with cervical tumors,and a clear diagnosis requires careful correlation with clinical history and immunophenotype.

关 键 词：结直肠肿瘤 腺瘤样腺癌 临床病理特征 免疫组织化学 鉴别诊断 

分 类 号：R735.3[医药卫生—肿瘤]