具有腺样囊性癌特征子宫颈癌的临床病理、免疫表型及HPV感染状态分析  

Clinicopathological,immunophenotypic,and HPV infection status analysis of cervical carcinoma with adenoid cystic carcinoma-like features

作　　者：孟祥超 王映梅 李轩 倪文静 秦扬 徐红 曾淑俊 张静 Meng Xiangchao;Wang Yingmei;Li Xuan;Ni Wenjing;Qin Yang;Xu Hong;Zeng Shujun;Zhang Jing(Department of Pathology,the First Affiliated Hospital of Air Force Medical University,Xi’an 710032,China)

机构地区：[1]空军军医大学第一附属医院病理科,西安710032

出　　处：《临床与实验病理学杂志》2025年第4期432-437,443,共7页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的探讨伴腺样囊性癌(adenoid cystic carcinoma,ACC)特征子宫颈癌的临床病理特征、免疫表型、高危型人乳头瘤病毒(high-risk human papillomavirus,hrHPV)感染状态、治疗和预后。方法收集10例具有ACC特征的子宫颈癌临床资料,回顾性分析患者的临床病理资料、组织学特征和免疫表型(EnVision法),并进行涵盖18种hrHPV E6/E7 mRNA的原位杂交检测。结果患者中位年龄67.5岁,包括4例活检标本和6例手术标本。除2例因体检偶然发现外,其余8例均存在无诱因阴道出血或接触性出血。肿瘤平均最大径4.5 cm(范围2.5~9.0 cm),8例患者获知肿瘤分期(Ⅰ期5例,Ⅱ、Ⅲ和Ⅳ期各1例)。随访时间8~42个月,除1例失访外,2例(ⅢC1和ⅣB期)术后1年内死亡。组织学上,4例具有单纯性ACC形态,5例为混合性癌(分别合并鳞状细胞癌、腺样基底细胞癌、高级别神经内分泌癌或癌肉瘤),ACC形态学表现为筛状、假腺样、管状、小梁状和(或)实性结构,1例混合性癌的淋巴结转移癌仅具有ACC形态。免疫表型:10例肿瘤p16和p63均呈弥漫强阳性、Ki67细胞增殖指数高(40%~90%),p53均为野生型,50%病例c-MYB仅少部分细胞阳性;此外,SOX10(8/9)和CD117(7/10)呈阳性。hrHPV E6/E7 mRNA的原位杂交检测结果证实病例均存在具有转录活性的HPV感染。结论具有ACC特征的子宫颈癌罕见,常发生于绝经后老年女性,属于HPV相关型高级别癌,临床分期是评估患者预后的重要因素,CD117和SOX10免疫组化染色有助于该类型肿瘤的病理诊断。Purpose To investigate the clinicopathological characteristics,immunophenotype,high-risk human papillomavirus(hrHPV)infection status,treatment,and prognosis of cervical carcinoma exhibiting adenoid cystic carcinoma(ACC)features.Methods Clinical data from 10 cases of cervical cancer with ACC features were collected.A retrospective analysis was proformed on the patients’clinicopathological data,histological features,and immunophenotype(EnVision method),along with in situ hybridization detection of hrHPV E6/E7 mRNA covering 18 hrHPV types.Results The median age of the patients was 67.5 years,comprising 4 biopsy specimens and 6 surgical specimens.Except for 2 cases detected incidentally during physical examination,the remaining 8 cases presented with unexplained vaginal bleeding or contact bleeding.The mean tumor diameter was 4.5 cm(range:2.5 to 9.0 cm),and tumor stages were available for 8 patients(5 cases in stageⅠand 1 case each in stages Ⅱ,Ⅲ,and Ⅳ).The follow-up period was 8 to 42 months,excluding 1 case lost to follow-up,2 cases(ⅢC1 and ⅣB)died within 1 year after surgery.Histologically,4 cases exhibited pure ACC morphology,while 5 cases were mixed carcinomas(combined with squamous cell carcinoma,adenoid basal cell carcinoma,high-grade neuroendocrine carcinoma,or carcinosarcoma,respectively).The characteristic ACC morphology manifested as cribriform,pseudo-glandular,tubular,trabecular,and/or solid patterns with one case mixed carcinoma’s lymph node metastasis showing only ACC morphology.Immunohistochemically,all 10 tumors exhibited diffuse strong positivity for p16 and p63,a high Ki67 proliferation index(40% to 90%),and wild-type p53 expression,and in 50% of cases,only a minority of cells were positive for c-MYB.Additionally,SOX10 was positive in 8 of 9 cases and CD117 was positive in 7 of 10 cases,respectively.In situ hybridization for hrHPV E6/E7 mRNA confirmed the presence of transcriptionally active HPV infection in all cases.Conclusion Cervical cancer with ACC features is rare,and predominan

关 键 词：子宫颈肿瘤 腺样囊性癌 高危型人乳头瘤病毒 免疫组织化学 mRNA原位杂交 

分 类 号：R737.33[医药卫生—肿瘤]