Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan.
Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto City, Kyoto, Japan.
J Obstet Gynaecol Res. 2024 Apr;50(4):758-763. doi: 10.1111/jog.15895. Epub 2024 Jan 31.
There have been no reported cases of neuroendocrine carcinoma (NEC) of the cervix with pagetoid spread (Pag-S). A 44-year-old woman came to our department because of abnormal cytology that persisted immediately after a radical hysterectomy for NEC of the cervix. A mapping biopsy in a large area from the vaginal wall to the vulva revealed that synaptophysin/Ki-67-positive tumor cells were scattered within the epithelium in multiple areas, suggesting a wide Pag-S of NEC. Because tumor cells were found beyond the vaginal wall, the anterior pelvic exenteration was performed. Since we could pathologically confirm the complete resection and no distant metastases were detected, no adjuvant therapy was performed. Four years have passed since the initial treatment without any tumor recurrence. It is known that the prognosis of NEC of the cervix that invades beyond the cervix is poor; however, if there is a Pag-S pattern, a radical surgical treatment can be considered.
尚未有宫颈神经内分泌癌（NEC）伴派杰样播散（Pag-S）的报道病例。一名 44 岁女性因宫颈 NEC 根治性子宫切除术后立即出现异常细胞学改变而就诊于我科。从阴道壁到外阴的大面积描记活检显示，在多个区域的上皮内散在着突触素/ Ki-67 阳性肿瘤细胞，提示存在广泛的 Pag-S 型 NEC。由于肿瘤细胞超出阴道壁，因此进行了前盆腔脏器切除术。由于我们可以在病理上确认完全切除且未发现远处转移，因此未进行辅助治疗。自初始治疗以来已经过去了 4 年，没有肿瘤复发的迹象。已知侵犯宫颈以外的宫颈 NEC 预后较差；然而，如果存在 Pag-S 模式，则可以考虑进行根治性手术治疗。
