Li Joshua J X, Lee Jacqueline H S, Chan Vicky T C, Yu Mei-Yung
Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Case Rep Pathol. 2018 Jun 11;2018:3972353. doi: 10.1155/2018/3972353. eCollection 2018.
A 67-year-old woman presented with postmenopausal vaginal bleeding. Full body imaging demonstrated an intrauterine mass with deep myometrial invasion but no nodal or other metastatic disease. Uterine curettage was performed. Histologically, the tumor was an endometrioid adenocarcinoma with sarcomatous element and a hepatoid component, the latter was immunohistochemically positive for alpha-fetoprotein, HepPar-1, and arginase-1. The patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Serum alpha-fetoprotein level decreased from 31896 ug/l preoperatively to 2063 ug/l postoperatively. Eight weeks later, a rise in serum alpha-fetoprotein was detected, and a biopsy-proven vaginal recurrence was diagnosed. Palliative chemotherapy led to tumor shrinkage and a concurrent decrease in the serum alpha-fetoprotein level. A rise in serum alpha-fetoprotein, refractory to second-line chemotherapy, was accompanied by subsequent development of ureteric obstruction, ascites, and radiological evidence of peritoneal metastases. This is an unusual case of uterine carcinosarcoma with an alpha-fetoprotein-producing hepatoid adenocarcinoma component. Serum alpha-fetoprotein level corresponds to disease recurrence and progression.
一名67岁女性因绝经后阴道出血就诊。全身影像学检查显示子宫内有肿物，侵及肌层深部，但无淋巴结或其他转移病灶。进行了子宫刮宫术。组织学检查显示，肿瘤为具有肉瘤成分和肝样成分的子宫内膜样腺癌，后者免疫组化检测甲胎蛋白、HepPar-1和精氨酸酶-1呈阳性。患者接受了全腹子宫切除术及双侧输卵管卵巢切除术。血清甲胎蛋白水平从术前的31896μg/L降至术后的2063μg/L。八周后，检测到血清甲胎蛋白升高，经活检证实为阴道复发。姑息化疗使肿瘤缩小，同时血清甲胎蛋白水平下降。二线化疗难治的血清甲胎蛋白升高，同时出现输尿管梗阻、腹水以及腹膜转移的影像学证据。这是一例罕见的子宫癌肉瘤病例，伴有产生甲胎蛋白的肝样腺癌成分。血清甲胎蛋白水平与疾病复发和进展相关。
