Wincewicz Andrzej, Lewitowicz Piotr, Urbaniak-Wąsik Sławka, Kanczuga-Koda Luiza, Koda Mariusz, Adamczyk-Gruszka Olga, Sulkowski Stanisław
Department of Anatomy, Faculty of Health Sciences, Jan Kochanowski Memorial University, Kielce, Poland;
Rom J Morphol Embryol. 2014;55(3 Suppl):1225-30.
Adenoid basal carcinoma (ABC) of uterine cervix is an extraordinary example of carcinoma with both basal and glandular cell types. Here we present such a case of ABC combined with invasive squamous cell carcinoma (SCC) of 55-year-old woman.
The tumor was stained with Hematoxylin-Eosin (HE), Mucicarmine, PAS/Alcian Blue, CK AE1/AE3, CK7, CD117 and Ki67.
The whitish-grey 1 cm in-depth infiltration of endocervix was composed of infiltrative coalescing areas of CK AE1/AE3 positive carcinoma with peripheral palisading of basal cell type with spaces lined by Mucicarmine- and Alcian Blue-positive benign looking, glandular epithelium. There were also foci of apparently malignant squamous epithelium with evident dyskeratosis. Thus, a lesion was diagnosed of adenoid basal carcinoma combined with invasive squamous cell carcinoma foci of uterine cervix. The tumor was further CD117 negative what favored diagnosis of ABC over adenoid cystic carcinoma (ACC). There were rare mitoses on HE slides but 60% of all tumor cells were positive for Ki67 that would partially contradict reported benign nature of ABC lesion. Moreover, tumor was CK7-positive and this finding was controversial and according to one report favored diagnosis of ABC-like adenosquamous carcinoma (ACC). Due to CK7 positivity and high index of Ki67, the neoplasm was re-classified as adenoid basal carcinoma-like tumor.
It seems reasonable to treat the patient in the same manner as in case of pure simple invasive squamous cell carcinoma because much more aggressive, minor component of invasive SCC was found within ABC in our case.
子宫颈腺样基底癌(ABC)是一种同时具有基底细胞和腺细胞类型的特殊癌。在此,我们报告一例55岁女性的ABC合并浸润性鳞状细胞癌(SCC)病例。
肿瘤进行苏木精-伊红(HE)染色、黏液卡红染色、PAS/阿尔辛蓝染色、细胞角蛋白AE1/AE3(CK AE1/AE3)染色、细胞角蛋白7(CK7)染色、CD117染色和Ki67染色。
宫颈管内灰白色1cm深度浸润灶由CK AE1/AE3阳性癌的浸润融合区组成,外周为基底细胞型栅栏状排列,其间有黏液卡红和阿尔辛蓝阳性的外观良性的腺上皮衬里的间隙。也有明显恶性的鳞状上皮灶伴明显角化不良。因此,诊断为子宫颈腺样基底癌合并浸润性鳞状细胞癌灶。肿瘤进一步检测显示CD117阴性,这支持ABC的诊断而非腺样囊性癌(ACC)。HE切片上有罕见的有丝分裂,但所有肿瘤细胞中有60% Ki67阳性,这与报道的ABC病变的良性性质部分矛盾。此外,肿瘤CK7阳性,这一发现存在争议,根据一份报告支持诊断为ABC样腺鳞癌(ACC)。由于CK7阳性和Ki67高指数,该肿瘤被重新分类为腺样基底癌样肿瘤。
鉴于在我们的病例中ABC内发现了更具侵袭性的小成分浸润性SCC,以与单纯浸润性鳞状细胞癌相同的方式治疗该患者似乎是合理的。