Scott Kerry, Bryson Gareth, Jamison Jackie, Coutts Michael, McCluggage W Glenn
Department of Pathology, Belfast Health and Social Care Trust, Belfast (K.S., W.G.M.) Department of Pathology, Queen Elizabeth University Hospital, Glasgow (G.B.) Department of Molecular Pathology, Antrim Area Hospital, Antrim (J.J.) Department of Pathology, Maidstone Hospital, Maidstone (M.C.), United Kingdom.
Int J Gynecol Pathol. 2018 Jan;37(1):74-81. doi: 10.1097/PGP.0000000000000387.
There have been occasional reports of primary cervical adenocarcinoma with areas of dedifferentiation resulting in morphologic mimicry of breast lobular carcinoma. We describe 4 cases of primary cervical squamous carcinoma with prominent acantholysis (3 cases), areas resembling breast lobular carcinoma (3 cases) or both (2 cases). All 4 tumors showed positivity with p63 and CK5/6 and 3 of 4 exhibited block-type immunoreactivity with p16. Two of the 4 cases contained high-risk human papillomavirus (types 16 and 18) on molecular testing; of the 2 cases which were human papillomavirus negative, 1 exhibited patchy nonblock immunoreactivity with p16. All cases exhibited some degree of loss of E-cadherin membranous staining in the areas of acantholysis and foci resembling breast lobular carcinoma. Three of 4 patients had extracervical spread at diagnosis; the fourth patient developed extracervical recurrence on follow-up. The initial FIGO stages were IB1, IIB (2 cases) and IVB. The 2 patients whose neoplasms were human papillomavirus negative developed distant metastases (supraclavicular, meningeal, and lung) during the course of their disease; the same 2 patients died of disease at periods of 4 mo and 1 yr after diagnosis. Cervical squamous carcinomas with acantholytic features and areas resembling breast lobular carcinoma are an unusual morphologic variant of squamous carcinoma. We consider the acantholysis and mimicry of breast lobular carcinoma to be part of a spectrum of morphologic changes, possibly related to loss of E-cadherin. These features can be regarded as a form of dedifferentiation which indicates a potential for aggressive behavior.
偶尔有原发性宫颈腺癌伴有去分化区域导致形态学上酷似乳腺小叶癌的报道。我们描述了4例原发性宫颈鳞状细胞癌，具有显著棘层松解（3例）、类似乳腺小叶癌的区域（3例）或两者皆有（2例）。所有4例肿瘤p63和CK5/6均呈阳性，4例中有3例p16呈块状免疫反应。4例中的2例分子检测含有高危人乳头瘤病毒（16型和18型）；在2例人乳头瘤病毒阴性的病例中，1例p16呈斑片状非块状免疫反应。所有病例在棘层松解区域和类似乳腺小叶癌的病灶中均表现出一定程度的E-钙黏蛋白膜染色缺失。4例患者中有3例在诊断时已有宫颈外扩散；第4例患者在随访中出现宫颈外复发。国际妇产科联盟（FIGO）初始分期为IB1、IIB（2例）和IVB。2例肿瘤为人乳头瘤病毒阴性的患者在病程中发生远处转移（锁骨上、脑膜和肺）；这2例患者在诊断后4个月和1年死于疾病。具有棘层松解特征和类似乳腺小叶癌区域的宫颈鳞状细胞癌是鳞状细胞癌一种不寻常的形态学变异。我们认为棘层松解和对乳腺小叶癌的模仿是一系列形态学改变的一部分，可能与E-钙黏蛋白缺失有关。这些特征可被视为一种去分化形式，提示有侵袭性行为的可能性。
