Proca D, Keyhani-Rofagha S, Copeland L J, Hameed A
Department of Pathology, Ohio State University, Columbus, USA.
Acta Cytol. 1998 Jul-Aug;42(4):978-82. doi: 10.1159/000331980.
In the female genital tract, neuroendocrine small cell carcinoma can occur in the endometrium as well as the cervix, ovary and vagina. This tumor has a high propensity for systemic spread and a poor prognosis. Small cell carcinoma of the endometrium is cytologically identical to its counterparts in the lung and other sites. Its characteristic appearance in a cervicovaginal smear should raise concern about small cell carcinoma. Other tumors of the uterus should be considered in the differential diagnosis, including adenocarcinoma with neuroendocrine features, small cell nonkeratinizing squamous cell carcinoma, endometrial stromal sarcoma, rhabdomyosarcoma, primitive neuroectodermal tumor, non-Hodgkin's lymphoma and metastatic breast carcinoma.
Case 1 was a 59-year-old, white female, and case 2 was a 47-year-old, white female. Both patients presented with vaginal bleeding. The Papanicolaou smears in both cases had similar, characteristic exfoliative cytology. The tumor cells were small and either single or arranged in groups and files. They had barely visible cytoplasm, darkly staining nuclei with finely stippled chromatin, and inconspicuous nucleoli. The characteristic molding of the nuclei was also present. Immuno-histochemical staining for neuron-specific enolase and synaptophysin was positive in tissue sections. Pancytokeratin, vimentin, muscle-specific actin, desmin, alpha-fetoprotein, S-100, glial fibrillary acid protein, common leukocyte antigen and chromogranin were negative.
When a uterine small cell carcinoma is suspected in a cervicovaginal smear, the similarity of cervical and endometrial small cell carcinoma requires a differential curettage and immunohistochemical demonstration of neuroendocrine differentiation in order to arrive at the final diagnosis.
在女性生殖道中，神经内分泌小细胞癌可发生于子宫内膜，也可发生于宫颈、卵巢和阴道。这种肿瘤具有较高的全身转移倾向且预后较差。子宫内膜小细胞癌在细胞学上与其在肺及其他部位的对应肿瘤相同。其在宫颈阴道涂片的特征性表现应引起对小细胞癌的关注。鉴别诊断时应考虑子宫的其他肿瘤，包括具有神经内分泌特征的腺癌、小细胞非角化鳞状细胞癌、子宫内膜间质肉瘤、横纹肌肉瘤、原始神经外胚层肿瘤、非霍奇金淋巴瘤及转移性乳腺癌。
病例1为一名59岁的白人女性，病例2为一名47岁的白人女性。两名患者均表现为阴道出血。两例患者的巴氏涂片均具有相似的特征性脱落细胞学表现。肿瘤细胞小，单个或成组排列。它们几乎看不到细胞质，细胞核深染，染色质呈细颗粒状，核仁不明显。细胞核的特征性镶嵌现象也存在。组织切片中神经元特异性烯醇化酶和突触素的免疫组织化学染色呈阳性。全细胞角蛋白、波形蛋白、肌肉特异性肌动蛋白、结蛋白、甲胎蛋白、S-100、胶质纤维酸性蛋白、普通白细胞抗原和嗜铬粒蛋白均为阴性。
当在宫颈阴道涂片中怀疑子宫小细胞癌时，宫颈和子宫内膜小细胞癌的相似性需要进行诊断性刮宫及神经内分泌分化的免疫组织化学证明，以得出最终诊断。
