Rubio Alejandro, Schuldt Maolly, Guarch Rosa, Laplaza Yolanda, Giordano Giovanna, Nogales Francisco F
Department of Pathology (A.R.), Complejo Hospitalario Universitario de Badajoz, Badajoz Hospital Universitario San Cecilio (M.S., F.F.N.), Universidad de Granada, Granada Complejo Hospitalario de Navarra (R.G., Y.L.), Hospital Virgen del Camino, Pamplona Università Degli Studi di Parma (G.G.), Parma PR, Italy.
Int J Gynecol Pathol. 2016 Mar;35(2):118-22. doi: 10.1097/PGP.0000000000000227.
This paper presents a clinicopathologic and immunohistochemical report of 2 gastrointestinal-type tumors, one in the endometrium and the other in the cervix. Both showed extensive invasion into the pelvic structures with acellular mucin, identical to pseudomyxoma but in the absence of appendiceal or ovarian tumors. Case 1 was an 81-yr-old female with a Stage III endometrial gastrointestinal-type adenocarcinoma who had had an endometrial polyp with intestinal metaplasia 4 years previously. Case 2 was a 68-yr-old female with Stage IIIB endocervical gastrointestinal-type adenocarcinoma. Both were associated with a pseudomyxoma type of invasion, which in the endometrial case was transmural through the myometrium, and in the cervical case involved parametria, pelvic floor, and lymph nodes. Immunohistochemically, both tumors had a gastrointestinal phenotype coexpressing cytokeratins 7 and 20, CDX2, villin, MUC2, MUC5AC, and MUC6 and were negative for human papillomavirus, analyzed by real-time polymerase chain reaction. The first case exemplifies intestinal endometrial metaplasia as a precursor lesion of the rare gastrointestinal type of adenocarcinoma and also proves its progression into carcinoma. The second case exemplifies the highly aggressive nature of cervical invasion forming mucin lakes. Extensive pseudomyxoma in the uterus and cervix was associated with high clinical stages with marked lymphovascular invasion and lymph node metastases.
本文报告了2例胃肠道型肿瘤的临床病理及免疫组化结果，1例位于子宫内膜，另1例位于宫颈。二者均显示广泛侵犯盆腔结构，伴有无细胞黏液，与黏液性囊腺瘤相同，但无阑尾或卵巢肿瘤。病例1为一名81岁女性，患有Ⅲ期子宫内膜胃肠道型腺癌，4年前曾有子宫内膜息肉伴肠化生。病例2为一名68岁女性，患有ⅢB期宫颈胃肠道型腺癌。二者均伴有黏液性囊腺瘤样浸润，在子宫内膜病例中为穿经肌层的透壁性浸润，在宫颈病例中累及宫旁组织、盆底和淋巴结。免疫组化显示，两例肿瘤均具有胃肠道表型，共表达细胞角蛋白7和20、CDX2、绒毛蛋白、MUC2、MUC5AC和MUC6，经实时聚合酶链反应分析，人乳头瘤病毒检测为阴性。首例病例证明肠型子宫内膜化生是罕见的胃肠道型腺癌的前驱病变，并证实其进展为癌。第二例病例显示宫颈浸润形成黏液湖具有高度侵袭性。子宫和宫颈广泛的黏液性囊腺瘤与高临床分期、显著的淋巴管浸润和淋巴结转移相关。
