Gamez Roberto G, Jessurun Jose, Berger Michael J, Pambuccian Stefan E
Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota 55455, USA.
Diagn Cytopathol. 2009 May;37(5):381-7. doi: 10.1002/dc.21027.
Cervical squamous cell carcinomas are rarely the cause of malignant effusions. Their identification can be relatively easy when keratinizing atypical squamous cells are present, but may be very difficult when only nonkeratinizing malignant cells are present. We present the case of a 47-year-old woman who presented with a large left pleural effusion after having recently completed chemoradiation therapy for stage IIB cervical squamous cell carcinoma. Cytologic examination of the fluid showed a uniform population of single atypical cells with finely vacuolated cytoplasm, ectoendoplasmic demarcation, cell-in-cell arrangements, and short rows of cells with intervening "windows," all features reminiscent of mesothelial cells. No keratinization or three-dimensional cell clusters were identified. A panel of immunohistochemical stains was performed on the cell block material, and the atypical cells were positive for cytokeratin 5/6, p63, and p16 but not for cytokeratin 7, calretinin, WT1, or Ber-EP4 or TTF1. These findings were consistent with metastatic squamous cell carcinoma. HPV DNA determination and typing by PCR confirmed the presence of HPV16 in an aliquot of pleural fluid. This is to our knowledge the first reported case of pleural fluid involved by metastatic squamous cell carcinoma where HPV DNA testing was used to confirm the origin of the metastasis. Despite its rarity, metastatic nonkeratinizing squamous cell carcinoma should be considered when a single cell population of large atypical cells is found in effusions. Immunoperoxidase stains and HPV testing can be performed to establish the diagnosis and confirm the origin from a cervical primary.
宫颈鳞状细胞癌很少引起恶性胸腔积液。当存在角化的非典型鳞状细胞时，其识别相对容易，但当仅存在非角化恶性细胞时，识别可能非常困难。我们报告一例47岁女性，她在近期完成IIB期宫颈鳞状细胞癌的放化疗后出现大量左侧胸腔积液。对胸腔积液进行细胞学检查发现，有一群形态均一的单个非典型细胞，胞质有细小空泡，内质界限清晰，有细胞内细胞排列以及短排细胞并伴有间隔“窗”，所有这些特征都让人联想到间皮细胞。未发现角化或三维细胞团。对细胞块材料进行了一组免疫组织化学染色，非典型细胞细胞角蛋白5/6、p63和p16呈阳性，但细胞角蛋白7、钙视网膜蛋白、WT1、Ber-EP4或TTF1呈阴性。这些发现与转移性鳞状细胞癌一致。通过聚合酶链反应（PCR）进行人乳头瘤病毒（HPV）DNA测定和分型，证实胸腔积液的一份样本中存在HPV16。据我们所知，这是首例通过HPV DNA检测来证实转移来源的转移性鳞状细胞癌累及胸腔积液的病例报告。尽管罕见，但当在胸腔积液中发现大量非典型细胞的单个细胞群时，应考虑转移性非角化鳞状细胞癌。可进行免疫过氧化物酶染色和HPV检测以确立诊断并确认源自宫颈原发灶。
