Talia Karen L, Arora Rupali, McCluggage W Glenn
Int J Gynecol Pathol. 2022 Mar 1;41(2):105-112. doi: 10.1097/PGP.0000000000000785.
Cervical clear cell carcinoma (CCC) is an HPV-independent tumor historically associated with in-utero exposure to diethylstilboestrol. With the cessation of diethylstilboestro use, most contemporary cases are sporadic and of uncertain pathogenesis, with no established precursor lesion. Following the detection of 3 incidental "early" (FIGO stage IA1) cervical CCCs, all of which displayed adjacent tubo-endometrial metaplasia, we examined further cases, including resection specimens, of this tumor in an attempt to delineate potential precursors. We identified tubo-endometrial metaplasia in proximity to the tumor in 5 of 5 additional primary cervical CCCs, with some tubo-endometrial glands exhibiting subtle mild cytologic atypia. This observation adds to the sparse existing literature proposing tubo-endometrial metaplasia as a precursor to sporadic cervical CCC, with possible progression via an "atypical" transitional phase to malignancy. We also review the published literature regarding possible precursor lesions of primary cervical CCC.
宫颈透明细胞癌（CCC）是一种与人类乳头瘤病毒（HPV）无关的肿瘤，历史上与子宫内接触己烯雌酚有关。随着己烯雌酚使用的停止，大多数当代病例为散发性，发病机制不明，且无公认的前驱病变。在检测到3例偶然发现的“早期”（国际妇产科联盟（FIGO）IA1期）宫颈CCC后，所有病例均显示相邻的输卵管子宫内膜化生，我们进一步检查了该肿瘤的其他病例，包括切除标本，试图明确潜在的前驱病变。我们在另外5例原发性宫颈CCC中，有5例在肿瘤附近发现了输卵管子宫内膜化生，一些输卵管子宫内膜腺体表现出轻微的细胞学非典型性。这一观察结果补充了现有的少量文献，这些文献提出输卵管子宫内膜化生是散发性宫颈CCC的前驱病变，可能通过“非典型”过渡阶段进展为恶性肿瘤。我们还回顾了关于原发性宫颈CCC可能的前驱病变的已发表文献。
