Clement P B, Zubovits J T, Young R H, Scully R E
Department of Pathology, Vancouver Hospital and Health Sciences Centre, Canada.
Int J Gynecol Pathol. 1998 Jul;17(3):211-22.
Malignant mullerian mixed tumors (MMMTs) of the uterine cervix are rare; less than 30 cases have been reported in the literature and only 14 have been described in detail. As a result, the clinical and pathologic features of these tumors are not well characterized. The clinicopathologic features of nine cervical MMMTs (all cases referred because of problems in differential diagnosis) are reported here and the literature on the previously described cases is reviewed. The patients ranged in age from 23 to 87 (mean 65) years. The initial manifestations were mainly vaginal bleeding or spotting or, less commonly, an abnormal Pap smear. All of the patients had a cervical mass on examination. Of the eight patients for whom staging information was available, seven were stage Ib and one was stage II. Treatment in six patients was hysterectomy with lymphadenectomy in five; postoperative radiation therapy, chemotherapy, or both were given to two of these patients. The remaining three patients were treated by local excision (with lymphadenectomy in one) followed by radiation therapy, chemotherapy, or both in two. Follow-up, available for seven patients, revealed recurrent pelvic tumor in two patients at 1.6 and 3.0 years, respectively; the former patient died from tumor at 3.5 years whereas the latter was alive with tumor at 4.5 years. Another patient was well for II years but died 13 years postoperatively from colonic adenocarcinoma. Four other patients were alive with no evidence of tumor at postoperative intervals of less than 2 years. Gross examination revealed polypoid or pedunculated masses 1.1 to 10.0 cm in maximal dimension that invaded the cervical wall in 50% of the hysterectomy specimens. On microscopic examination, three tumors contained a predominant or exclusive epithelial component of basaloid carcinoma, two contained squamous cell carcinoma, and four contained adenocarcinoma (endometrioid in three and nonspecific in one). In seven tumors, the sarcomatous component was homologous, usually resembling fibrosarcoma or endometrial stromal sarcoma; in four of these tumors, myxoid change was prominent. Two tumors contained heterologous sarcomatous elements. In three patients, a pure carcinoma abutted the MMMT: an adenoid basal carcinoma in two (with a minor component of in situ and invasive squamous cell carcinoma in each) and an endometrioid endocervical adenocarcinoma in one. These findings, combined with analysis of the previously reported cases, indicate that cervical MMMTs, compared to their counterparts in the corpus, are more commonly confined to the uterus at presentation, may have a better prognosis, and frequently have a nonglandular epithelial component.
子宫颈恶性苗勒管混合瘤（MMMTs）很罕见；文献报道不足30例，仅有14例有详细描述。因此，这些肿瘤的临床和病理特征尚未得到充分认识。本文报告9例宫颈MMMTs的临床病理特征（所有病例均因鉴别诊断问题转诊），并复习此前报道病例的相关文献。患者年龄范围为23至87岁（平均65岁）。初始表现主要为阴道出血或点滴出血，较少见的是巴氏涂片异常。所有患者检查时均有宫颈肿物。在有分期信息的8例患者中，7例为Ib期，1例为II期。6例患者接受了子宫切除术，其中5例同时行淋巴结切除术；其中2例患者术后接受了放疗、化疗或两者联合治疗。其余3例患者接受局部切除（1例同时行淋巴结切除术），其中2例随后接受了放疗、化疗或两者联合治疗。7例患者有随访资料，分别在1.6年和3.0年时发现2例患者盆腔肿瘤复发；前者在3.5年时死于肿瘤，而后者在4.5年时仍带瘤生存。另1例患者术后11年情况良好，但术后13年死于结肠腺癌。其他4例患者术后随访时间不足2年，均存活且无肿瘤证据。大体检查显示息肉样或带蒂肿物，最大径1.1至10.0 cm，50%的子宫切除标本中肿物侵犯宫颈壁。显微镜检查显示，3例肿瘤主要或仅含有基底样癌上皮成分，2例含有鳞状细胞癌，4例含有腺癌（3例为子宫内膜样腺癌，1例为非特异性腺癌）。7例肿瘤的肉瘤成分是同源性的，通常类似纤维肉瘤或子宫内膜间质肉瘤；其中4例肿瘤黏液样变明显。2例肿瘤含有异源性肉瘤成分。3例患者中，纯癌紧邻MMMT：2例为腺样基底癌（各伴有少量原位和浸润性鳞状细胞癌成分），1例为子宫内膜样宫颈腺癌。这些发现，结合对既往报道病例的分析，表明与子宫体部的MMMTs相比，宫颈MMMTs在初诊时更常局限于子宫，预后可能更好，且常含有非腺上皮成分。
