宫颈非典型类癌合并原位腺癌的临床病理特征分析
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摘要
目的探讨宫颈非典型类癌合并原位腺癌的临床病理特征。方法分析l例宫颈非典型类癌合并原位腺癌的临床表现、病理形态学特征及免疫组化特点,并结合文献进行讨论。结果患者女性,46岁,阴道出血6个月。MR检查提示宫颈占位性病变,行全子宫、双附件及盆腔淋巴结切除手术。肿瘤组织由原位腺癌及神经内分泌肿瘤(非典型类癌)两种组织学形态组成,两种成分各自独立生长。神经内分泌肿瘤CK、CD56、Syn和CD117(+);原位腺癌CK、CEA、p16和CDX2(+)。结论宫颈非典型类癌非常罕见,其合并原位腺癌更属罕见。非典型类癌需要与低分化腺癌、类癌、大细胞神经内分泌癌、腺样基底细胞癌和转移性非典型类癌等鉴别。
Objective To study the clinicopathological features,diagnosis,and differential diagnosis of atypical carcinoid combined with adenocarcinoma in situ( AIS) of the uterine cervix. Methods A case of atypical carcinoid combined with AIS in the uterine cervix was investigated by clinical findings,histopathology and immunohistochemistry,and related literatures were reviewed. Results A 46-year-old woman presented with vaginal bleeding for 6 months. MRI examination showed an uterine cervical mass. The patient was treated with hysterectomy, bilateral salpingoophorectomy and lymphadenectomy. Microscopic examination revealed that the tumor contained two kinds of histological morphology,atypical carcinoid and AIS,which grew independently. Immunohistochemically,CK,CD56,Syn and CD117 were positive in neuroendocrine tumor,while AIS was positive for CK,CEA,p16 and CDX2. Conclusions Atypical carcinoid combined with AIS of the uterine cervix is rare. Differential diagnosis of atypical carcinoid includes poorly-differentiated adenocarcinoma,carcinoid,large cell neuroendocrine tumor,adenoid basal carcinoma and secondary atypical carcinoid.
Objective To study the clinicopathological features,diagnosis,and differential diagnosis of atypical carcinoid combined with adenocarcinoma in situ( AIS) of the uterine cervix. Methods A case of atypical carcinoid combined with AIS in the uterine cervix was investigated by clinical findings,histopathology and immunohistochemistry,and related literatures were reviewed. Results A 46-year-old woman presented with vaginal bleeding for 6 months. MRI examination showed an uterine cervical mass. The patient was treated with hysterectomy, bilateral salpingoophorectomy and lymphadenectomy. Microscopic examination revealed that the tumor contained two kinds of histological morphology,atypical carcinoid and AIS,which grew independently. Immunohistochemically,CK,CD56,Syn and CD117 were positive in neuroendocrine tumor,while AIS was positive for CK,CEA,p16 and CDX2. Conclusions Atypical carcinoid combined with AIS of the uterine cervix is rare. Differential diagnosis of atypical carcinoid includes poorly-differentiated adenocarcinoma,carcinoid,large cell neuroendocrine tumor,adenoid basal carcinoma and secondary atypical carcinoid.
引文
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[10]Kurman RJ,Carcangiu ML,Herrington C S,et al.WHO Classification of Tumours of Female Reproductive Orgams[M].lyon:IARC Press,2014.
[11]Bifulco G,Mandato VD,Giampaolino P,et al.Small cell neuroendocrine cervical carcinoma with 1-year follow-up:case report and review[J].Anticancer Res,2009,29(2):477-484.
[12]Sato Y,Shimamoto T,Amada S,et al.Large cell neuroendocrine carcinoma of the uterine cervix:a clinicopathologic study of six cases[J].Int J Gynecol Pathol,2003,22(3):226-230.
[13]Wang KL,Wang TY,Huang YC,et al.Human papillomavirus type and clinical manifestation in seven cases of large-cell neuroendocrine cervical carcinoma[J].J Formos Med Assoc,2009,108(5):428-432.
[14]Andersson S,Mints M,Wilander E.Results of cytology and highrisk human papillomavirus testing in females with cervical adenocarcinoma in situ[J].Oncol Lett,2013,6(1):215-219.
[15]Pocrnich CE,Ramalingam P,Euscher ED,Neuroendocrine carcinoma of the endometrium:A clinicopathologic study of 25Cases[J].Am J Surg Pathol,2016,40(5):577-586.
[16]郑珂,刘从容,陈余朋.宫颈原位腺癌的临床病理及免疫组织化学研究[J].福建医科大学学报,2014,48(5):295-298.
[2]Hara H,Ishii E,Hondo T,et al.Cytological features of atypical carcinoid combined with adenocarcinoma of the uterine cervix[J].Diagn Cytopathol,2012,40(8):724-728.
[3]Yoshida Y,Sato K,Katayama K,et al.Atypical metastatic carcinoid of the uterine cervix and review of the literature[J].J Obstet Gynaecol Res,2011,37(6):636-640.
[4]Koch CA,Azumi N,Furlong MA,et al.Carcinoid syndrome caused by an atypical carcinoid of the uterine cervix[J].J Clin Endocrinol Metab,1999,84(11):4209-4213.
[5]Wistuba II,Thomas B,Behrens C et al.Molecular abnormalities associated with endocrine tumors of the uterine cervix[J].Gynecol Oncol,1999,72(01):3-9.
[6]Boruta DM,Schorge JO,Duska LA,et al.Multimodality therapy in early-stage neuroendocrine carcinoma of the uterine cervix[J].Gynecol Oncol,2001,81(01):82-87.
[7]Mc Cusker ME,CotéTR,Clegg LX,et al.Endocrine tumors of the uterine cervix:Incidence,demographics,and survival with comparison to squamous cell carcinoma[J].Gynecol Oncol,2003,88(03):333-339.
[8]Wang KL,Yang YC,Wang TY,et al.Neuroendocrine carcinoma of the uterine cervix:A clinicopathologic retrospective study of 31 cases with prognostic implications[J].J Chemother,2006,18(02):209-216.
[9]Gilks CB,Young RH,Gersell DJ,et al.Large cell neuroendocrine[correcred]carcinoma of the uterine cervix:A clinicopathologic study of 12 cases[J].Am J Surg Pathol,1997,21(08):905-914.
[10]Kurman RJ,Carcangiu ML,Herrington C S,et al.WHO Classification of Tumours of Female Reproductive Orgams[M].lyon:IARC Press,2014.
[11]Bifulco G,Mandato VD,Giampaolino P,et al.Small cell neuroendocrine cervical carcinoma with 1-year follow-up:case report and review[J].Anticancer Res,2009,29(2):477-484.
[12]Sato Y,Shimamoto T,Amada S,et al.Large cell neuroendocrine carcinoma of the uterine cervix:a clinicopathologic study of six cases[J].Int J Gynecol Pathol,2003,22(3):226-230.
[13]Wang KL,Wang TY,Huang YC,et al.Human papillomavirus type and clinical manifestation in seven cases of large-cell neuroendocrine cervical carcinoma[J].J Formos Med Assoc,2009,108(5):428-432.
[14]Andersson S,Mints M,Wilander E.Results of cytology and highrisk human papillomavirus testing in females with cervical adenocarcinoma in situ[J].Oncol Lett,2013,6(1):215-219.
[15]Pocrnich CE,Ramalingam P,Euscher ED,Neuroendocrine carcinoma of the endometrium:A clinicopathologic study of 25Cases[J].Am J Surg Pathol,2016,40(5):577-586.
[16]郑珂,刘从容,陈余朋.宫颈原位腺癌的临床病理及免疫组织化学研究[J].福建医科大学学报,2014,48(5):295-298.