Yuan Chang-Tsu, Lin Ming-Chieh, Kuo Kuang-Ting, Wang Tsung-Hsi, Mao Tsui-Lien
Department of Pathology, National Taiwan University Hospital, No. 7 Chung-Shan S. Rd., Taipei, 100, Taiwan.
Graduate Institute of Pathology, National Taiwan University, No. 7 Chung-Shan S. Rd., Taipei, Taiwan.
Virchows Arch. 2016 Sep;469(3):351-6. doi: 10.1007/s00428-016-1978-x. Epub 2016 Jun 22.
Benign, premalignant, and malignant endocervical glandular lesions occasionally show a gastric phenotype. We report 2 cases of gastric-type adenocarcinoma in situ (AIS) of the endocervix, not associated with lobular endocervical glandular hyperplasia or gastric-type adenocarcinoma. Cytologically, both showed endocervical glands with slightly enlarged nuclei, distinctive nucleoli, pseudostratified strips, and intracytoplasmic golden yellow mucin. Histologically, both lesions were situated in preexisting endocervical glands and presented columnar cells with voluminous pale eosinophilic cytoplasm and evident nuclear atypia. In case 1, the lesion was located at the mid-zone of the endocervical canal and, in case 2, at the outer endocervical canal with extension to the transformation zone and prominent intestinal metaplasia. In both, the cells showed voluminous cytoplasm containing gastric-type mucin, stained red by combined alcian blue/periodic acid-Schiff stain. Immunohistochemically, both lesions were positive for HIK1083 and p53, while negative for p16 and ER. Human papilloma virus (HPV) DNA was not detected by polymerase chain reaction. Our cases illustrate that gastric-type AIS can occur without lobular endocervical glandular hyperplasia. The lesions can occur in the outer cervical canal and present extensive intestinal differentiation. Awareness of this rare type of endocervical glandular lesion is important since they are pathogenetically different from the more common HPV-associated lesions and may become more prevalent in the HPV-eradicating era.
良性、癌前和恶性宫颈管腺性病变偶尔会表现出胃型表型。我们报告2例宫颈原位胃型腺癌（AIS），与宫颈管小叶状腺增生或胃型腺癌无关。细胞学上，两者均显示宫颈管腺体细胞核轻度增大、核仁明显、假复层条带以及胞浆内金黄色黏液。组织学上，两个病变均位于原有的宫颈管腺体中，呈现柱状细胞，胞浆丰富、淡嗜酸性，核异型明显。病例1中，病变位于宫颈管中段；病例2中，病变位于宫颈管外段并延伸至转化区，伴有显著的肠化生。两者的细胞均显示含有胃型黏液的丰富胞浆，经阿尔辛蓝/过碘酸-希夫联合染色染成红色。免疫组化方面，两个病变HIK1083和p53均为阳性，而p16和ER为阴性。聚合酶链反应未检测到人乳头瘤病毒（HPV）DNA。我们的病例表明，胃型AIS可在无宫颈管小叶状腺增生的情况下发生。病变可发生于宫颈管外段并呈现广泛的肠化生。认识到这种罕见的宫颈管腺性病变很重要，因为它们在发病机制上与更常见的HPV相关病变不同，并且在HPV根除时代可能会变得更加普遍。
