Zhang Lan-Zhi, Huang Li-Yan, Huang An-Liang, Liu Jin-Xing, Yang Fan
Department of Pathology, West China Second University Hospital, Sichuan University.
Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
Medicine (Baltimore). 2019 Jan;98(1):e13852. doi: 10.1097/MD.0000000000013852.
Squamous carcinoma is the most common malignancy of vagina. Adenoid cystic carcinoma (ACC) in the vagina is very rare.
In the present study, we present a 45-year-old woman with a palpable swelling in the vagina. The patient reported body paresthesia, chest congestion, expiratory dyspnea, and itching in the thigh root.
The ultrasound results revealed inhomogeneous echoes of the muscular layer in the middle and distal of the vagina, and probed a slightly richer blood flow signal. Then biopsy was performed. On microscopic examination, it was observed that tumor cells were arranged in a tubular or cribriform pattern, and exhibited a consistent size, small nuclei, and nuclear fission. The myoepithelium was lined around the glandular cavity, but the myoepithelium was tumorous. Immunohistochemistry was performed for further verification. Vimentin was positive in mesenchyme and CK-P was positive in epithelial cells. P63 and calponin were spotted, which were focal positive around the glandular cavity. Finally, the patient was diagnosed as ACC.
At last, the patient chose chemoradiotherapy, not surgical excision.
The patient is alive and well 13 months after the initial diagnosis.
ACC in the vagina is extremely rare. To our knowledge, this report is the first case of ACC arising from the vagina in English-language literature. Extensive surgical section of the tumour and chemoradiotherapy are recommended for therapy. Because of rarity, the prognosis of ACC in vagina is not known.
鳞状细胞癌是阴道最常见的恶性肿瘤。阴道腺样囊性癌(ACC)非常罕见。
在本研究中,我们报告一名45岁女性,其阴道可触及肿物。患者自述身体感觉异常、胸部闷塞、呼气性呼吸困难及大腿根部瘙痒。
超声结果显示阴道中下段肌层回声不均匀,探及血流信号稍丰富。随后进行活检。显微镜检查发现肿瘤细胞呈管状或筛状排列,大小一致,核小,可见核分裂。肌上皮围绕腺腔排列,但肌上皮呈肿瘤性。进行免疫组化进一步验证。波形蛋白在间充质中呈阳性,细胞角蛋白-P在上皮细胞中呈阳性。在腺腔周围发现P63和钙调蛋白呈局灶性阳性。最终,患者被诊断为ACC。
最后,患者选择了放化疗,而非手术切除。
初次诊断后13个月,患者仍存活且情况良好。
阴道ACC极为罕见。据我们所知,本报告是英文文献中首例源自阴道的ACC病例。建议对肿瘤进行广泛手术切除及放化疗。由于罕见,阴道ACC的预后尚不清楚。