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胃型宫颈内膜腺癌的诊断与治疗:病例报告及文献复习。

Diagnosis and management of gastric-type endocervical adenocarcinoma: A case report and review of the literature.

机构信息

Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH, USA.

Division of Obstetrics & Gynecology, The Ohio State University, Columbus, OH, USA.

出版信息

Gynecol Oncol. 2024 Jun;185:165-172. doi: 10.1016/j.ygyno.2024.02.024. Epub 2024 Feb 29.

Abstract

Gastric-type endocervical adenocarcinoma (GEA), a rare subtype of cervical cancer, has garnered increasing attention recently for its distinctive histopathological features, unique classification, genetic characteristics, and variable clinical outcomes compared to squamous cell and adenocarcinoma subtypes. Historically, GEA has evolved from a poorly understood entity to a distinct subtype of cervical adenocarcinoma, only recently recognized in the 2020 World Health Organization (WHO) classification. Accordingly, characteristic morphological features define GEA, shedding light on the diagnostic challenges and potential misclassification that can occur in clinical practice. Genetic alterations, including KRAS, ARID1A, and PIK3CA mutations, play a pivotal role in the development and progression of GEA. This article reviews a case of GEA and aims to provide a contemporary overview of the genetic mutations and molecular pathways implicated in GEA pathogenesis, highlighting potential therapeutic targets and the prospects of precision medicine in its management. Patients with GEA have variable clinical outcomes, with some exhibiting aggressive behavior while others follow a more indolent course. This review examines the factors contributing to this heterogeneity, including stage at diagnosis, histological grade, and genetic alterations, and their implications for patient prognoses. Treatment strategies for GEA remain a topic of debate and research. Here, we summarize the current therapeutic options, including surgery, radiation therapy, and chemotherapy, while also exploring emerging approaches, such as targeted therapies and immunotherapy. This article provides a comprehensive overview of GEA, synthesizing current knowledge from historical perspectives to contemporary insights, focusing on its classification, genetics, outcomes, and therapeutic strategies.

摘要

胃型宫颈腺癌(GEA)是一种罕见的宫颈癌亚型,由于其独特的组织病理学特征、独特的分类、遗传特征以及与鳞状细胞癌和腺癌亚型相比不同的临床结局,近年来受到越来越多的关注。历史上,GEA 从一种人们知之甚少的实体演变为一种独特的宫颈腺癌亚型,直到最近才在 2020 年世界卫生组织(WHO)分类中被确认。因此,特征性的形态学特征定义了 GEA,揭示了在临床实践中可能出现的诊断挑战和潜在的分类错误。遗传改变,包括 KRAS、ARID1A 和 PIK3CA 突变,在 GEA 的发生和发展中起着关键作用。本文回顾了一例 GEA 病例,旨在提供 GEA 发病机制中涉及的遗传突变和分子途径的现代概述,强调潜在的治疗靶点和精准医学在其管理中的前景。GEA 患者的临床结局各不相同,有些表现出侵袭性行为,而有些则表现出更惰性的病程。本综述探讨了导致这种异质性的因素,包括诊断时的分期、组织学分级和遗传改变,以及它们对患者预后的影响。GEA 的治疗策略仍然是一个有争议的研究课题。在这里,我们总结了目前的治疗选择,包括手术、放疗和化疗,同时还探讨了新兴的方法,如靶向治疗和免疫治疗。本文全面概述了 GEA,从历史角度到当代观点综合了当前的知识,重点介绍了它的分类、遗传学、结局和治疗策略。

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