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[宫颈基底样鳞状细胞癌的临床病理分析]

[Clinicopathological analysis of cervical basaloid squamous cell carcinoma].

作者信息

Wang L Q, Wang Y, Jin W, Cao C, Ma Y Q, Ding X H, Liu A J

机构信息

Department of Pathology, General Hospital of PLA, Beijing 100853, China.

出版信息

Zhonghua Fu Chan Ke Za Zhi. 2019 Jan 25;54(1):7-12. doi: 10.3760/cma.j.issn.0529-567x.2019.01.003.

DOI:10.3760/cma.j.issn.0529-567x.2019.01.003
PMID:30695899
Abstract

To investigate the clinical and histopathological features of cervical basal squamous cell carcinoma (BSCC). A retrospective analysis of 10 cases of cervical BSCC was carried out. The clinical data and all the pathological sections were reviewed, the related immunohistochemical results were statistically analyzed, the clinicopathological features were analyzed, and then followed the prognosis. (1) Clinical features: the median onset age of BSCC in cervix was 51 years old (ranged 35-69 years old), 5 of them were postmenopausal women. Vaginal bleeding was often seen in clinic (7 cases). Of the 10 cervical BSCC patients, 5 tested HPV types. All of them were HPV positive, including 2 cases of HPV 16 positive and 1 case of high-risk HPV positive. At the time of colposcopy, 3 cases showed exogenous nodular mass, 3 cases showed endogenous infiltrating mass, and 4 cases had unclear type of mass.(2)Treatment: of the 10 patients, 8 underwent hysterectomy+bilateral adnexal excision+pelvic lymphadenectomy, of which 6 underwent radiotherapy or chemotherapy after operation.Radiotherapy and chemotherapy were performed only in 2 cases. (3) Pathological features: histologically, the tumor cells were nests and stripe like growth, which were composed of basal like tumor cells. The cells had obvious heteromorphosis, less cytoplasm, deep dyed nuclei and common nuclear mitosis, and there were often palisade like structures around the cell nests, and some cells in the center of the cell nests were found to have acne like necrosis. It could be mixed with normal squamous cell carcinoma and squamous epithelial lesion. Among the 10 patients, 6 had immunohistochemical results. BSCC mainly expressed p16 and squamous cell markers such as p63, cytokeratin (CK) 5/6 and p40 protein, the positive expression rates were 3/3, 3/3, 2/2 and 3/3, respectively. A few expressed CK7 protein, and the positive expression rate was 1/3. (4) Prognosis: follow-up time ranged from 1 week to 64 months, and 2 cases were lost to follow-up. Among the 8 follow-up patients, 3 had iliac bone, lung or skin metastasis, and 5 had no recurrence or metastasis during the follow-up period. BSCC of cervix is a rare malignant tumor of cervix associated with high-risk HPV infection, p16 is more positive. The treatment is similar to that of normal cervical squamous cell carcinoma. Surgical resection and radiotherapy and chemotherapy are the most effective methods according to the clinical stage. At present, the disease is considered to be highly aggressive and the poor prognosis.

摘要

探讨宫颈基底样鳞状细胞癌(BSCC)的临床及组织病理学特征。对10例宫颈BSCC进行回顾性分析。复习临床资料及所有病理切片,对相关免疫组化结果进行统计学分析,分析临床病理特征,随后随访预后。(1)临床特征:宫颈BSCC发病年龄中位数为51岁(范围35 - 69岁),其中5例为绝经后女性。临床上常出现阴道流血(7例)。10例宫颈BSCC患者中,5例检测HPV类型。均为HPV阳性,其中2例HPV 16阳性,1例高危HPV阳性。阴道镜检查时,3例表现为外生性结节状肿物,3例表现为内生性浸润性肿物,4例肿物类型不明确。(2)治疗:10例患者中,8例行子宫全切术 + 双侧附件切除术 + 盆腔淋巴结清扫术,其中6例术后行放疗或化疗。仅2例单纯行放疗和化疗。(3)病理特征:组织学上,肿瘤细胞呈巢状和条索状生长,由基底样肿瘤细胞组成。细胞有明显异型性,胞质较少,核深染,核分裂常见,细胞巢周围常有栅栏状结构,细胞巢中央部分细胞可见粉刺样坏死。可与正常鳞状细胞癌及鳞状上皮病变混合存在。10例患者中,6例有免疫组化结果。BSCC主要表达p16及p63、细胞角蛋白(CK)5/6和p40蛋白等鳞状细胞标志物,阳性表达率分别为3/3、3/3、2/2和3/3。少数表达CK7蛋白,阳性表达率为1/3。(4)预后:随访时间1周 - 64个月,2例失访。8例随访患者中,3例有髂骨、肺或皮肤转移,5例随访期间无复发或转移。宫颈BSCC是一种与高危HPV感染相关的罕见宫颈恶性肿瘤,p16阳性率较高。治疗与正常宫颈鳞状细胞癌相似。根据临床分期,手术切除及放化疗是最有效的方法。目前认为该疾病具有高度侵袭性,预后较差。

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