子宫颈小细胞神经内分泌癌的临床病理分析

目的 分析宫颈小细胞神经内分泌癌(SCNCC)的临床病理特征、诊断、治疗及预后.方法 回顾性分析2006年3月-2010年7月在广西医科大学附属肿瘤医院诊治的12例SCNCC患者的临床病理资料,包括临床特征(患者的年龄、临床分期、肿瘤类型及大小)、病理特征(肿瘤浸润、淋巴结转移、免疫组化检测结果 )、治疗及预后.结果 (1)临床特征:12例患者的平均年龄38.7岁(28～57岁);临床分期:按国际妇产科联盟(FIGO,2009年)标准,Ⅰ b1～Ⅱa期6例,Ⅱb～Ⅳ期6例;肿瘤类型及大小:9例为外生型菜花样肿物,其中7例直径≥4 cm,2例＜4 cm;2例为宫颈糜烂;1例宫颈光滑但颈管增粗.(2)病理特征:8例手术患者(Ⅰ b1～Ⅲb期)中,肿瘤浸润达间质深层(≥1/2宫颈间质)6例,达间质全层2例;盆腔淋巴结转移4例.免疫组化检测显示,嗜铬素A(CgA)、突触素、神经元特异性烯醇化酶(NSE)、细胞角蛋白(CK)、CD56的阳性率分别为8/12、9/10、4/4、4/4、4/4.(3)治疗及预后:8例手术患者中,7例行广泛性子宫切除+双侧(或单侧)附件切除+盆腔(或加腹主动脉旁)淋巴清扫术,1例行广泛性子宫切除+双侧卵巢移位+盆腔淋巴清扫术.其中,4例术前、8例术后接受了辅助治疗(化疗或加放疗).中位随访时间为3个月(1～22个月),8例手术患者中,4例发生转移,其无瘤生存时间分别为3～17个月,其中2例分别于术后8.5、11.3个月死亡;4例患者仍存活,在随访期间,未见明确肿瘤复发和转移表现.未手术的4例患者(Ⅲb～Ⅳ期)中,1例予同步放化疗者确诊后已存活10.1个月,仍在随访中;2例未治疗患者分别于确诊后0.6及1.3个月死亡;1例未治疗患者失访.结论 SCNCC恶性程度高,易发生远处转移,预后差,诊断应联合组织病理学检查及免疫组化法检测,采用以手术为主的综合治疗可改善部分患者的预后.

Abstract：

Objective To analyse the clinico-pathologic characteristics,diagnosis,therapy and prognostic of small cell neuroendocrine carcinoma of the cervix(SCNCC).Methods The clinic-pathological features of 12 patients with SCNCC treated in Tumor Hospital of Guangxi Medical University,admitted during March 2006 to July 2010,were analyzed retrospectively.Results Of 12 patients,the mean age was 38.7 years(rang 28-57 years),6 had stages Ⅰ b1-Ⅱa,6 had stagesⅡb-Ⅳ.Among 8 patients(Ⅰ b1-Ⅲb)underwent surgery,4 of them received neoadjuvant chemotherapy,8 of them received adjuvant chemotherapy and(or)radiotherapy.All had greater than one-half stromal invasion,4 patients had positive pelvic lymph nodes metastases.The positive ratio of the chromogranin(CgA),synaptophysin,neuronspecific enolase(NSE),cytokeratins(CK),CD56 tested by immunohistochemical staining were 8/12,9/10,4/4,4/4,4/4,respectively.Median follow-up period was 3 months(1-22 months).Among 8 patients underwent surgery,2 patients developed lung metastases,1 patient developed liver and lung metastases,1 patient developed liver metastases concurrently with bone metastases,disease-free survival (DFS)were 3 months(Ⅰ b2 with positive lymph nodes),4.6 months(Ⅱ a),7 months(Ⅰ b1),17 months (Ⅰ b2);2 patient died(8.5 and 11.3 months,respectively)after surgery;4 patients are alive and show no evidence of disease.Among 4 patients untreated,1 patients received concurrent chemoradiation and are alive for 10.1 months.Two patient untreated(Ⅲb,Ⅳ)died after 0.6 and 1.3 months final diagnosis,respectively.One patient Was lost follow-up.Conclusions SCNCC is a highly malignant tumor with rare morbility,propensity for distant spread and dismal prognosis.Final diagnosis of SCNCC depends on pathomorphology and immunohistochemical analysis.Combined therapeutic modalities may in favor of survival in some patients.

Clinicopathologic analysis of small cell neuroendocrine carcinoma of the cervix

Objective To analyse the clinico-pathologic characteristics,diagnosis,therapy and prognostic of small cell neuroendocrine carcinoma of the cervix(SCNCC).Methods The clinic-pathological features of 12 patients with SCNCC treated in Tumor Hospital of Guangxi Medical University,admitted during March 2006 to July 2010,were analyzed retrospectively.Results Of 12 patients,the mean age was 38.7 years(rang 28-57 years),6 had stages Ⅰ b1-Ⅱa,6 had stagesⅡb-Ⅳ.Among 8 patients(Ⅰ b1-Ⅲb)underwent surgery,4 of them received neoadjuvant chemotherapy,8 of them received adjuvant chemotherapy and(or)radiotherapy.All had greater than one-half stromal invasion,4 patients had positive pelvic lymph nodes metastases.The positive ratio of the chromogranin(CgA),synaptophysin,neuronspecific enolase(NSE),cytokeratins(CK),CD56 tested by immunohistochemical staining were 8/12,9/10,4/4,4/4,4/4,respectively.Median follow-up period was 3 months(1-22 months).Among 8 patients underwent surgery,2 patients developed lung metastases,1 patient developed liver and lung metastases,1 patient developed liver metastases concurrently with bone metastases,disease-free survival (DFS)were 3 months(Ⅰ b2 with positive lymph nodes),4.6 months(Ⅱ a),7 months(Ⅰ b1),17 months (Ⅰ b2);2 patient died(8.5 and 11.3 months,respectively)after surgery;4 patients are alive and show no evidence of disease.Among 4 patients untreated,1 patients received concurrent chemoradiation and are alive for 10.1 months.Two patient untreated(Ⅲb,Ⅳ)died after 0.6 and 1.3 months final diagnosis,respectively.One patient Was lost follow-up.Conclusions SCNCC is a highly malignant tumor with rare morbility,propensity for distant spread and dismal prognosis.Final diagnosis of SCNCC depends on pathomorphology and immunohistochemical analysis.Combined therapeutic modalities may in favor of survival in some patients.