Yang Liwen, Wang Yangyang, Cai Jian, Xiong Ying, Li Juan, Zhou Qi, Ye Nan, Lai Hua, Liu Tianjiao, Zhou Liuying
Department of Ultrasonography, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology, Chengdu, China.
Department of Gynecology and Obstetrics, Chengdu Xinjin District Maternal and Child Health Care Hospital, Chengdu, China.
Front Oncol. 2025 May 14;15:1572438. doi: 10.3389/fonc.2025.1572438. eCollection 2025.
Gastric-type endocervical adenocarcinoma (G-EAC) is a rare and aggressive subtype of cervical cancer which is not associated with human papillomavirus (HPV) infection but has poor prognosis because of its high invasiveness and resistance to chemoradiotherapy. The early and accurate diagnosis of G-EAC is challenging owing to its nonspecific symptoms and relatively normal cytological and histological manifestations.
The present study retrospectively analyzed the demographic and clinical characteristics, and cervical medical imaging features of 10 patients diagnosed with G-EAC at our institution during a five-year period. Postoperative cervical pathological features were examined, and followed-up information was collected. Novel ultrasonographic features of G-EAC were also summarized.
The patients aged 24-70 years (mean: 49.6 ± 11.6). Their clinical presentations included vaginal discharge (60%), irregular vaginal bleeding (40%), and contact bleeding (30%). Nine patients were HPV negative. Ultrasound examination revealed that there were two, three, two, and two cases of types I (multicystic), II (cystic-solid), III (solid), and IV (nearly normal cervix) G-EAC, respectively. There were four CA199 + and two CA125 + cases. Pathology examination confirmed two cases of synchronous mucinous metaplasia and neoplasia of the female genital tract and one case of Peutz-Jeghers syndrome and multiple gastrointestinal polyps. Ultrasonography for cystic lesions revealed a "cosmos sign". Two patients with types I and II G-EAC exhibited vesicular echoes involving the lower uterine segment. In four cases, vesicular echoes were observed within the myometrium. This case series highlights the heterogeneous manifestations, complex imaging patterns, and multifaceted pathology of G-EACs.
Ultrasonography can facilitate the early diagnosis of G-EAC for relatively specific features, such as "cosmos signs" and "vesicular implantation signs." The latter refers to ultrasound manifestations of multicystic or cystic-solid lesions of the cervix accompanied by vesicular lesion in the lower uterine segment and/or vesicular implantation in the myometrium.
胃型宫颈内膜腺癌（G-EAC）是宫颈癌中一种罕见且侵袭性强的亚型，与人乳头瘤病毒（HPV）感染无关，但因其高侵袭性和对放化疗的耐药性，预后较差。由于其症状不具特异性，细胞学和组织学表现相对正常，G-EAC的早期准确诊断具有挑战性。
本研究回顾性分析了我院5年内诊断为G-EAC的10例患者的人口统计学和临床特征、宫颈医学影像特征。检查术后宫颈病理特征，并收集随访信息。还总结了G-EAC的新型超声特征。
患者年龄24 - 70岁（平均：49.6±11.6）。临床表现包括阴道分泌物增多（60%）、不规则阴道出血（40%）和接触性出血（30%）。9例患者HPV阴性。超声检查显示，I型（多囊性）、II型（囊实性）、III型（实性）和IV型（宫颈近乎正常）G-EAC分别有2例、3例、2例和2例。有4例CA199升高和2例CA125升高。病理检查确诊2例女性生殖道黏液化生与肿瘤同步发生，1例为黑斑息肉综合征和多发胃肠道息肉。囊性病变的超声检查显示“宇宙征”。2例I型和II型G-EAC患者子宫下段出现水泡样回声。4例患者子宫肌层内观察到水泡样回声。该病例系列突出了G-EAC的异质性表现、复杂的影像模式和多方面的病理学特征。
超声检查可因“宇宙征”和“水泡样种植征”等相对特异的特征而有助于G-EAC的早期诊断。后者指宫颈多囊性或囊实性病变伴有子宫下段水泡样病变和/或子宫肌层水泡样种植的超声表现。
