Munakata Satoru, Hosoi Ayako, Yamamoto Toshiya
Departments of Pathology (S.M.) Obstetrics and Gynecology (A.H., T.Y.), Sakai City Hospital Organization, Sakai City Medical Center, Sakai, Osaka, Japan.
Int J Gynecol Pathol. 2018 Jul;37(4):368-371. doi: 10.1097/PGP.0000000000000432.
Invasive micropapillary carcinoma (IMPC) is a rare subtype of adenocarcinoma found in many organs. Only 1 case of IMPC of the uterine cervix has been reported. We report a rare case of IMPC in the uterine cervix. A 61-yr-old woman presented to our hospital for vaginal bleeding and abdominal pain. A papillary tumor was found in the uterine cervix. Cervical cytology revealed abnormal cells suggesting carcinoma in situ and adenocarcinoma. A follow up biopsy revealed adenocarcinoma. She underwent radical hysterectomy and bilateral adnexectomy. Histologically, carcinoma in situ and IMPC were found in the uterine cervix. Lymphatic infiltration was present in the cerix and in the right cardinal ligament. A pelvic lymph node metastasis was also identified. Clinical FIGO stage was IIb and pathologic stage was pT2bN1M0. Postoperative positron emission tomography-computed tomography revealed paraaortic lymph node metastasis. She is alive with disease 2 yr 9 mo after surgery. Positive p16 immunostaining and high-risk human papilloma virus in situ hybridization revealed human papilloma virus infection. Interleukin-17 was expressed in the tumor cells which might be related to the extensive neutrophilic infiltration and tumor progression. This is the first case report in which interleukin-17 expression is observed in the tumor cells of IMPC.
浸润性微乳头状癌（IMPC）是一种在多个器官中发现的腺癌罕见亚型。子宫颈IMPC仅报道过1例。我们报告1例子宫颈IMPC罕见病例。一名61岁女性因阴道出血和腹痛前来我院就诊。在子宫颈发现一个乳头状肿瘤。宫颈细胞学检查发现异常细胞，提示原位癌和腺癌。后续活检显示为腺癌。她接受了根治性子宫切除术和双侧附件切除术。组织学检查发现子宫颈存在原位癌和IMPC。宫颈及右侧主韧带存在淋巴浸润。还发现了盆腔淋巴结转移。临床国际妇产科联盟（FIGO）分期为IIb期，病理分期为pT2bN1M0。术后正电子发射断层扫描-计算机断层扫描显示腹主动脉旁淋巴结转移。术后2年9个月，她仍带瘤生存。p16免疫染色阳性和高危型人乳头瘤病毒原位杂交显示有人乳头瘤病毒感染。肿瘤细胞中表达白细胞介素-17，这可能与广泛的中性粒细胞浸润和肿瘤进展有关。这是首例在IMPC肿瘤细胞中观察到白细胞介素-17表达的病例报告。
