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12岁少女宫颈透明细胞癌1例报告

Clear Cell Carcinoma of Cervix in a 12-Year-Old Girl: A Case Report

  • 摘要: 患者12岁,因“阴道流血2+月,盆腔肿物待诊”于2019年9月19日入院。本例患者及家属均明确否认既往己烯雌酚暴露史。入院后予完善相关检查后于全麻下行宫腔镜探查术,术中取宫颈赘生物组织行冰冻切片,病理结果示宫颈恶性肿瘤,遂行经腹广泛全子宫切除术+双侧输卵管切除术+双侧卵巢移位+盆腔淋巴结清扫+腹主动脉旁淋巴结取样。术后切除组织病理示:宫颈透明细胞癌,癌浸润宫颈间质深1/3层,并向下累及阴道壁;癌转移至左闭孔淋巴结、左髂内外淋巴结。切除组织免疫组化染色示:细胞角蛋白7(CK7)(+)、细胞角蛋白20(CK20)(−)、天冬氨酸蛋白酶A(Napsin-A)(+)、细胞黏附分子CD15(+)、肝细胞核因子-1β(HNF-1β)(+)、Sal样蛋白4(SALL-4)(−)、抑癌基因P16蛋白(+)、雌激素受体(ER)(+)、孕激素受体(PR)(−)、抑癌基因P53蛋白灶性+、抑癌基因WT-1蛋白(−)、抗原Ki67阳性率约40%。诊断:宫颈透明细胞癌 ⅢC1p期,术后全身化疗(氟尿嘧啶+顺铂)4周期,25次三维后装放射治疗,随访至今,未见明显复发迹象。此病临床表现与宫颈鳞癌基本相同,但若患者年龄较小,则容易被误诊为功能失调性子宫出血等,需加以鉴别。

     

    Abstract: The 12-year-old patient was admitted to the hospital on September 19, 2019 for “vaginal bleeding for 2+ months and pelvic mass to be diagnosed”. The patient and her family explicitly denied any previous history of diethylstilbestrol exposure. After admission, relevant examinations were conducted and hysteroscopic exploration was performed under general anesthesia. During the procedure, cervical neoplasms were extracted and pathology results indicated cervical cancer. Then, extensive transabdominal hysterectomy+bilateral salpingectomy+bilateral ovarian transposition+pelvic lymph node dissection+para-aortic lymph node sampling were performed. Postoperative pathology analysis of the removed tissue showed that clear cell carcinoma of cervix (CCAC) had infiltrated into 1/3 of the cervical stroma and there was downward involvement of the vaginal wall; the cancer metastasized to the left obturator lymph node and the left internal and external iliac lymph nodes. Immunohistochemical staining of the removed tissue showed the following results: cytokeratin 7 (+), cytokeratin 20 (−), Napsin-A (+), cell adhesion molecule CD15 (+), heatocyte nuclear factor-1 β (+), Sal-like protein 4 (−), tumor suppressor gene P16 protein (+), estrogen receptor (+), progesterone receptor (−), tumor suppressor gene P53 protein (focal positive), tumor suppressor gene WT-1 protein (−) and Ki67 antigen (about 40% positive). The patient was diagnosed with CCAC stage ⅢC1p. Four cycles of postoperative systemic chemotherapy (fluorouracil+cisplatin) and 25 times of three-dimensional afterloading radiotherapy were performed. The patient did follow-up visits and did not show obvious signs of recurrence. The clinical manifestations of this disease are basically the same as those of cervical squamous cell carcinoma, and if the patient is younger, it can be easily misdiagnosed as dysfunctional uterine bleeding, indicating the need for differential diagnosis.

     

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