子宫透明细胞癌33例临床病理分析
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摘要
目的探讨子宫透明细胞癌的临床病理特征、诊断及预后。方法回顾性分析33例子宫透明细胞癌的临床病理特征、免疫表型、随访资料并复习相关文献,与对照组15例子宫颈普通型腺癌、15例子宫内膜样腺癌免疫组化结果进行统计学比较。结果 33例子宫透明细胞癌患者年龄33～82岁,平均55. 1岁;其中9例子宫颈透明细胞癌中2例失访,2例死亡,5例无复发;24例子宫内膜透明细胞癌中1例失访,4例死亡,19例健在,3例复发。免疫组化标记ER、PR、HNF1β、Napsin A、P504S、p53、p16的阳性率分别为3. 03%(1/33)、0 (0/33)、96. 97%(32/33)、51. 52%(17/33)、36. 36%(12/33)、9. 09%(3/33)、100. 00%(33/33)。ER、PR、Napsin A和P504S表达在透明细胞癌与对照组之间差异有统计学意义(P <0. 05),而HNF1β、p53在各组间表达差异无统计学意义(P> 0. 05)。结论子宫透明细胞癌应与伴鳞状上皮化生的子宫内膜样癌等相鉴别,免疫组化标记Napsin A比HNF1β的特异性高,鉴别诊断应采用Napsin A、P504S等一组标志物。
Purpose To investigate the clinicopathological features,diagnosis and prognosis of uterine clear cell carcinoma. Methods 33 cases of uterine clear cell carcinoma were retrospectively analyzed for the morphological features,immunophenotype,follow-up,and relevant literature was reviewed. The results of immunohistochemistry were compared with those of 15 cases of endocervical adenocarcinoma and 15 cases of endometrial endometrioid carcinoma in the control group. Results 33 patients with uterine clear cell carcinoma aged from 33 to 82 years,with an average age of 55. 1 years. In 9 cases of cervical clear cell carcinoma,2 patients were lost to follow-up,2 died,and 5were alive without recurrence. In 24 cases of endometrial clear cell carcinoma,1 patient was lost to follow-up,4 died,19 survived,and 3 relapsed. The immunohistochemical expression rates of ER,PR,HNF1β,Napsin A,P504 S,p53 and p16 were 3. 03%(1/33),0(0/33),96. 97%(32/33),51. 52%(17/33),36. 36%( 12/33),9. 09%( 3/33) and 100%(33/33),respectively. The differences of ER,PR,Napsin A and P504 S between the clear cell carcinoma and the control group were statistically significant( P < 0. 05),while the expression of HNF1β and p53 was not statistically significant( P >0. 05). Conclusion Uterine clear cell carcinoma should be differentiated from endometrioid carcinoma with squamous metaplasia. Napsin A is a more specific marker than HNF1β,and a panel of immunohistochemical markers including Napsin A and P504 S are recommended in the differential diagnoses.
Purpose To investigate the clinicopathological features,diagnosis and prognosis of uterine clear cell carcinoma. Methods 33 cases of uterine clear cell carcinoma were retrospectively analyzed for the morphological features,immunophenotype,follow-up,and relevant literature was reviewed. The results of immunohistochemistry were compared with those of 15 cases of endocervical adenocarcinoma and 15 cases of endometrial endometrioid carcinoma in the control group. Results 33 patients with uterine clear cell carcinoma aged from 33 to 82 years,with an average age of 55. 1 years. In 9 cases of cervical clear cell carcinoma,2 patients were lost to follow-up,2 died,and 5were alive without recurrence. In 24 cases of endometrial clear cell carcinoma,1 patient was lost to follow-up,4 died,19 survived,and 3 relapsed. The immunohistochemical expression rates of ER,PR,HNF1β,Napsin A,P504 S,p53 and p16 were 3. 03%(1/33),0(0/33),96. 97%(32/33),51. 52%(17/33),36. 36%( 12/33),9. 09%( 3/33) and 100%(33/33),respectively. The differences of ER,PR,Napsin A and P504 S between the clear cell carcinoma and the control group were statistically significant( P < 0. 05),while the expression of HNF1β and p53 was not statistically significant( P >0. 05). Conclusion Uterine clear cell carcinoma should be differentiated from endometrioid carcinoma with squamous metaplasia. Napsin A is a more specific marker than HNF1β,and a panel of immunohistochemical markers including Napsin A and P504 S are recommended in the differential diagnoses.
引文
[1] Improta G,Pettinato A,Hogdall E,et al. Ovarian clear cell carcinoma:from morphology to molecular biology[J]. Appl Immunohistochem Mol Morphol, 2018. doi:10. 1097/PAI.0000000000000662.
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[5] Ju B,Wang J,Yang B,et al. Morphologic and immunohistochemical study of clear cell carcinoma of the uterine endometrium and cervix in comparison to ovarian clear cell carcinoma[J]. Int J Gynecol Pathol,2018,37(4):388-396.
[6]钱萍,高宝莲.卵巢及子宫透明细胞癌、子宫内膜样癌中Napsin A、TTF-1、PAX8及CA125的表达及意义[J].临床与实验病理学杂志,2017,33(2):192-194.
[7] Fadare O,Zhao C,Khabele D,et al. Comparative analysis of Napsin A, alpha-methylacyl-coenzyme A racemase(AMACR,P504S),and hepatocyte nuclear factor 1 beta as diagnostic markers of ovarian clear cell carcinoma:an immunohistochemical study of 279 ovarian tumours[J]. Pathology,2015,47(2):105-111.
[8] Hughes C S,Mc Conechy M K,Cochrane D R,et al. Quantitative profiling of single formalin fixed tumour sections:proteomics for translational research[J]. Sci Rep,2016,6:34949.
[9]郭嘉骐,尧良清,袁蕾.子宫颈透明细胞腺癌的研究进展[J].国际妇产科学杂志,2016,43(6):686-689.
[10] Huo D,Anderson D,Herbst A L. Follow-up of patients with clear-cell adenocarcinoma of the vagina and cervix[J]. N Engl J Med,2018,378(18):1746-1748.
[11] Ueno S,Sudo T,Oka N,et al. Absence of human papillomavirus infection and activation of PI3K-AKT pathway in cervical clear cell carcinoma[J]. Int J Gynecol Cancer,2013,23(6):1084-1091.
[12] Cochrane D R,Tessier-Cloutier B,Lawrence K M,et al. Clear cell and endometrioid carcinomas:are their differences attributable to distinct cells of origin[J]. J Pathol,2017,243(1):26-36.
[13] Nakamura K,Nakayama K,Minamoto T,et al. Lynch syndromerelated clear cell Carcinoma of the cervix:a case report[J]. Int J Mol Sci,2018,19(4):E979.
[14] De Lair D F,Burke K A,Selenica P,et al. The genetic landscape of endometrial clear cell carcinomas[J]. J Pathol,2017,243(2):230-241.
[15] Bae H S,Kim H,Young K S,et al. Should endometrial clear cell carcinoma be classified as Type II endometrial carcinoma[J]. Int J Gynecol Pathol,2015,34(1):74-84.
[16] Cetinkaya N,Selcuk 6)I,Ozdal B,et al. Prognostic factors in endometrial clear cell carcinoma[J]. Arch Gynecol Obstet,2017,295(1):189-195.
[17] Xu Y,Hanna R K,Elshaikh M A. Adjuvant therapy of uterine clear cell carcinoma:a review[J]. Arch Gynecol Obstet,2016,293(3):485-492.
[2] Obata Y,Yamashita Y,Takahashi K,et al. MET amplification in endometrial cancers with clear-cell carcinoma components[J].Pathol Int,2018,68(6):367-373.
[3] Hariri N,Qarmali M,Fadare O. Endometrial serous carcinoma with clear-cell change:frequency and immunohistochemical analysis[J]. Int J Surg Pathol,2018,26(2):126-134.
[4] Lim D,Ip P P,Cheung A N,et al. Immunohistochemical comparison of ovarian and uterine endometrioid carcinoma,endometrioid carcinoma with clear cell change,and clear cell carcinoma[J]. Am J Surg Pathol,2015,39(8):1061-1069.
[5] Ju B,Wang J,Yang B,et al. Morphologic and immunohistochemical study of clear cell carcinoma of the uterine endometrium and cervix in comparison to ovarian clear cell carcinoma[J]. Int J Gynecol Pathol,2018,37(4):388-396.
[6]钱萍,高宝莲.卵巢及子宫透明细胞癌、子宫内膜样癌中Napsin A、TTF-1、PAX8及CA125的表达及意义[J].临床与实验病理学杂志,2017,33(2):192-194.
[7] Fadare O,Zhao C,Khabele D,et al. Comparative analysis of Napsin A, alpha-methylacyl-coenzyme A racemase(AMACR,P504S),and hepatocyte nuclear factor 1 beta as diagnostic markers of ovarian clear cell carcinoma:an immunohistochemical study of 279 ovarian tumours[J]. Pathology,2015,47(2):105-111.
[8] Hughes C S,Mc Conechy M K,Cochrane D R,et al. Quantitative profiling of single formalin fixed tumour sections:proteomics for translational research[J]. Sci Rep,2016,6:34949.
[9]郭嘉骐,尧良清,袁蕾.子宫颈透明细胞腺癌的研究进展[J].国际妇产科学杂志,2016,43(6):686-689.
[10] Huo D,Anderson D,Herbst A L. Follow-up of patients with clear-cell adenocarcinoma of the vagina and cervix[J]. N Engl J Med,2018,378(18):1746-1748.
[11] Ueno S,Sudo T,Oka N,et al. Absence of human papillomavirus infection and activation of PI3K-AKT pathway in cervical clear cell carcinoma[J]. Int J Gynecol Cancer,2013,23(6):1084-1091.
[12] Cochrane D R,Tessier-Cloutier B,Lawrence K M,et al. Clear cell and endometrioid carcinomas:are their differences attributable to distinct cells of origin[J]. J Pathol,2017,243(1):26-36.
[13] Nakamura K,Nakayama K,Minamoto T,et al. Lynch syndromerelated clear cell Carcinoma of the cervix:a case report[J]. Int J Mol Sci,2018,19(4):E979.
[14] De Lair D F,Burke K A,Selenica P,et al. The genetic landscape of endometrial clear cell carcinomas[J]. J Pathol,2017,243(2):230-241.
[15] Bae H S,Kim H,Young K S,et al. Should endometrial clear cell carcinoma be classified as Type II endometrial carcinoma[J]. Int J Gynecol Pathol,2015,34(1):74-84.
[16] Cetinkaya N,Selcuk 6)I,Ozdal B,et al. Prognostic factors in endometrial clear cell carcinoma[J]. Arch Gynecol Obstet,2017,295(1):189-195.
[17] Xu Y,Hanna R K,Elshaikh M A. Adjuvant therapy of uterine clear cell carcinoma:a review[J]. Arch Gynecol Obstet,2016,293(3):485-492.