Talia Karen L, Wong Richard Wing-Cheuk, McCluggage W Glenn
Department of Pathology, Box Hill Hospital, Melbourne, Vic., Australia (K.L.T.) Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (R.W.-C.W.) Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK (W.G.M.).
Int J Gynecol Pathol. 2019 May;38(3):276-282. doi: 10.1097/PGP.0000000000000529.
The incidence of cervical adenocarcinoma, both absolute and relative to squamous cell carcinoma, is increasing. Most cervical adenocarcinomas are human papillomavirus associated, although non-human papillomavirus-associated neoplasms exist; the latter include gastric-type adenocarcinoma (GAS) and clear cell carcinoma (CCC). Histologically, these 2 tumors may superficially resemble one other and although morphologic evaluation usually permits a correct diagnosis, immunohistochemistry may be required to resolve diagnostic uncertainty, especially in a small biopsy specimen. Markers of CCC include hepatocyte nuclear factor 1 beta (HNF1β) and Napsin A. In order to explore the utility of these markers in distinguishing between GAS and CCC, we stained 24 cases of GAS (19 cervical, 5 vaginal), 3 of cervical gastric-type adenocarcinoma in situ (gAIS) and 14 CCCs (13 cervical, 1 vaginal) with these antibodies. We found HNF1β expression in 21 of 23 cases of GAS (91.3%; there was no material available for staining in 1 case), 3/3 cases of gAIS (100%) and 10 of 14 (71.4%) CCCs. Napsin A was expressed in 4 of 24 (16.7%) cases of GAS, 0 of 3 (0%) gAIS, and 11 of 14 (78.6%) CCC. On the basis of these findings, Napsin A is of value in resolving diagnostic confusion between GAS and CCC, whereas HNF1β lacks specificity and its use in this setting is discouraged.
宫颈腺癌的发病率，无论是绝对值还是相对于鳞状细胞癌的相对发病率，都在上升。大多数宫颈腺癌与人乳头瘤病毒相关，尽管也存在非人类乳头瘤病毒相关的肿瘤；后者包括胃型腺癌（GAS）和透明细胞癌（CCC）。从组织学上看，这两种肿瘤可能表面上彼此相似，虽然形态学评估通常能做出正确诊断，但可能需要免疫组织化学来解决诊断上的不确定性，尤其是在小活检标本中。CCC的标志物包括肝细胞核因子1β（HNF1β）和Napsin A。为了探讨这些标志物在区分GAS和CCC中的作用，我们用这些抗体对24例GAS（19例宫颈，5例阴道）、3例宫颈原位胃型腺癌（gAIS）和14例CCC（13例宫颈，1例阴道）进行了染色。我们发现，23例GAS中有21例（91.3%；1例无可用染色材料）、3例gAIS中的3例（1%）和14例CCC中的10例（71.4%）表达HNF1β。24例GAS中有4例（16.7%）、3例gAIS中有0例（0%）、14例CCC中有11例（78.6%）表达Napsin A。基于这些发现，Napsin A在解决GAS和CCC之间的诊断混淆方面有价值，而HNF1β缺乏特异性，不建议在此情况下使用。
