子宫颈小细胞癌——一种特殊类型宫颈癌

目的 了解子宫颈小细胞癌(SCCC)的临床病理与生物学行为特征,探讨其治疗方法。方法回顾性分析6例SCCC患者的临床病理资料及随访记录。结果Ib期Ⅰ例、Ⅱa期2例、Ⅲb期3例。盆腔淋巴结转移2例,肝等器官转移4例,对6例患者采用手术+放疗+化疗或放疗+化疗的综合治疗,2例分别已存活30、20个月,另4例分别存活10、11、13、14个月后死亡。结论 子宫颈小细胞癌与肺小细胞癌的组织病理学和生物学行为特征相似,早期易发生盆腔淋巴结和远处转移,对化学治疗比较敏感。对早期患者应行广泛性子宫切除术+盆腔淋巴结清扫术,术后给予辅助性放疗和化疗;对晚期患者应采用放疗和化疗。     

子宫颈梭形细胞鳞癌6例临床病理观察

目的:探讨子宫颈梭形细胞鳞癌(SCSCC)病理特征、诊断及鉴别诊断。方法:收集2015年11月至2022年2月术前未接受放化疗的子宫颈鳞状细胞癌病例4837例,对其中的6例子宫颈SCSCC病例行免疫组织化学染色、人乳头瘤病毒(HPV)RNA原位杂交及网状纤维染色。结果:子宫颈SCSCC占同期所有子宫颈鳞状细胞癌的0.12%(6/4837),平均年龄49.2岁。4例合并普通型浸润性鳞癌,1例合并鳞状细胞原位癌,1例为单纯SCSCC。6例子宫颈SCSCC p53蛋白均呈野生型表达,5例与HPV感染有关。网状纤维染色显示网状纤维包绕肿瘤细胞巢。结论:子宫颈SCSCC可以合并普通型浸润性鳞状细胞癌或鳞状细胞原位癌,与HPV感染相关或不相关,预后差。SCSCC易被误诊为肉瘤或癌肉瘤,熟悉其临床病理学特点有助于正确诊断及治疗。     

Ⅰb和Ⅱa期子宫颈癌的手术治疗

回顾性复习经手术治疗的子宫颈浸润癌１２４例，包括鳞癌２８例、腺癌３０例、腺鳞癌３例及未分化癌２例。其中１８例术前期别估计低于术后（１４．５％）。Ⅰ期和Ⅱ期病例均有不同比例的宫体和盆腔淋巴结转移，但无１例卵巢转移。有１７例６０岁或以上患者接受广泛性子宫切除及盆腔淋巴结清扫术，未见手术并发症显著升高。提示：术前准确估计期别是影响手术治疗的重要因素，对包括腺癌的Ⅰｂ期病例手术可予保留卵巢，老年妇女并非为     

子宫颈鳞状细胞癌中细胞凋亡相关基因产物的免疫组织化学研究

目的：研究子宫颈鳞状细胞癌组织中细胞凋亡的相关基因表达及其与临床病理特征和患者预后的关系。方法：用免疫组织化学ＬＳＡＢ方法，分析５１份子宫颈鳞癌石蜡包埋组织中细胞凋亡相关基因ｐ５３、Ｃ－ｍｙｃ、ｂｃｌ－２及ｂａｘ的表达情况。另取石蜡包埋的正常子宫颈组织５份、上皮内瘤样病变（ＣＩＮ）组织８份作为对照。结果：１．ｐ５３、Ｃ－ｍｙｃ、ｂｃｌ－２和ｂａｘ在子宫颈鳞癌中的表达率分别为５２．９４％（２７／５１）、４９．０２％（２５／５１）、４３．１３（２２／５１）及５２．９４（２７／５１），其中ｐ５３、Ｃ－ｍｙｃ表达与正常子宫颈组织及ＣＩＮ比较差异有显著性（Ｐ＜０．０５）。２．子宫颈鳞癌中ｍｔｐ５３表达多见于组织分化程度低、有淋巴结转移及不良预后的患者。Ｃ－ｍｙｃ在有淋巴结转移及预后不良患者中表达显著增高。在分化程度高、无淋巴结转移患者中ｂｃｌ－２高表达。在临床分期晚、分化程度低、有淋巴结转移患者中ｂａｘ高表达。３．ｐ５３与ｂｃｌ－２以及ｂｃｌ－２与ｂａｘ表达间呈负相关；ｐ５３与ｂａｘ以及Ｃ－ｍｙｃ与ｂａｘ表达间呈正相关。结论：细胞凋亡相关基因ｐ５３、Ｃ－ｍｙｃ、ｂｃｌ－２及ｂａｘ在子宫颈鳞癌的发生、发展中起一定作用，?     

子宫颈小细胞癌

子宫颈小细胞癌张美琴王坚蔡树模宫颈小细胞癌（ｓｍａｌｃｅｌｃａｒｃｉｎｏｍａｏｆｔｈｅｃｅｒｖｉｘ，ＳＣＣＣ）罕见，治疗效果差，国内尚未见报道。本文报道我院收治的ＳＣＣＣ２例并复习文献，将此病的临床和病理特征综述如下。病例报告例１患者５０岁，主诉为绝...     

子宫颈小细胞癌10例临床与预后分析

目的 :研究子宫颈小细胞癌 (SCCC)的临床病理、生物学行为特征及预后 ,探讨其治疗方法。方法 :回顾性分析 10例SCCC患者的临床病理资料及随访记录。结果 :SCCCⅠb期 2例、Ⅱa期 4例、Ⅲb期 4例 ,SCCC早期即可发生盆腔淋巴结转移 ,并很容易转移至肺、肝等器官 ;对 10例患者采用手术 +放疗 +化疗或放疗 +化疗的综合治疗 ,5例分别已存活 37、2 7、16、10、9个月 ,另 5例分别存活 10、10、11、13、14个月后死亡。结论 :SCCC与肺小细胞癌的组织病理学和生物学行为特征相似 ,早期容易发生盆腔淋巴结转移和远处转移 ,对化学治疗比较敏感 ,早期患者应行子宫广泛性切除术 +盆腔淋巴结清扫术 ,术后给予辅助性放疗和化疗 ;晚期患者应采用放疗 +化疗。化疗目的在于预防或治疗远处转移性病变     

子宫颈病变及子宫颈癌的细胞病理诊断

对５１例巴氏分级属非癌及４９例巴氏分级属癌或高度可疑癌患者的子宫颈和子宫腔刮片进行细胞病理诊断，结果表明，用细胞病理学方法观察和分析刮片细胞，可以将巴氏分级诊断所不能区分的宫颈腺性糜烂，化生、上皮内瘤变及不同组织类型的子宫颈瘤予以分清，达到疾病诊断的目的，对癌变可以进行组织类型及分化程度的判断。提示：细胞病理诊断方法估巴氏分级诊断方法。     

子宫颈小细胞癌八例临床病理分析

目的 研究宫颈小细胞癌的临床病理特征、治疗方法和预后.方法 回顾性分析1999年1月至2005年12月间中国医学科学院中国协和医科大学肿瘤医院妇瘤科收治的8例宫颈小细胞癌患者的临床及病理资料.结果 8例患者均表现为不规则阴道流血或接触性出血.临床分期按1994年国际妇产科联盟分期标准为Ⅰ b1期1例、Ⅰ b2期2例、Ⅱ b期2例、Ⅲb期3例.组织学特点为体积小的圆形或短梭形细胞,形态大小较一致,细胞质少,核深染,染色质细,核仁不明显,核分裂象多见.7例行免疫组化染色,神经元特异性烯醇化酶均为阳性.3例Ⅰ b期和1例Ⅲb期患者行手术治疗,术后辅助化疗(或加放疗),生存时间分别为64、22、14和6个月.2例Ⅱ b期和2例Ⅲb期患者行放、化疗,生存时间分别为25、9、10和5个月.结论 联合光镜和免疫组化法检查可提高宫颈小细胞癌诊断的准确率.治疗应采用综合治疗,尤其应重视化疗的作用.     

开腹与腹腔镜手术治疗子宫颈残端癌的临床疗效分析

目的:探讨子宫颈残端癌临床表现及预后,并分析开腹手术与腹腔镜手术治疗子宫颈残端癌的疗效差异。方法:回顾性分析2009年1月至2019年12月在四川大学华西第二医院接受手术治疗的子宫颈残端癌患者的临床资料、随访生存情况,对比开腹组和腹腔镜组子宫颈残端癌的围手术期结局和生存结局。结果:共纳入64例子宫颈残端癌患者,病理类型包括鳞癌52例(81.3%),非鳞癌12例(18.7%);所有患者均接受残端子宫颈癌广泛切除手术,48例(75.0%)为开腹手术,16例(25.0%)为腹腔镜手术;国际妇产科联盟(FIGO,2018年)分期：Ⅰ期36例(56.3%),Ⅱ期15例(23.4%),Ⅲ期13例(20.3%)。随访期内7例出现复发,6例死亡。开腹组患者的5年无病生存率为89.5%,腹腔镜组为92.3%,差异无统计学意义((印)P(正)=0.670);开腹组患者的5年总体生存率为93.6%,腹腔镜组为90.9%,差异无统计学意义((印)P(正)=0.952)。但开腹组术中出血量明显高于腹腔镜组(500 ml vs 100 ml,(印)P(正)<0.001)。结论:子宫颈残端癌治疗预后较好,生存率较高,与开腹手术相比,腹腔镜手术并不增加子宫颈残端癌的复发风险,也未降低生存率,两组肿瘤学结局相似。     

Ib和Ⅱa期子宫颈癌的手术治疗

回顾性复习经手术治疗的子宫颈浸润癌１２４例，包括鳞癌２８例、腺癌３０例、腺鳞癌３例及未分化癌２例。其中１８例术前期别估计低于术后（１４．５％）。Ⅰ期和Ⅱ期病例均有不同比例的宫体和盆腔淋巴结转移，但无１例卵巢转移。有１７例６０岁或以上患者接受广泛性子宫切除及盆腔淋巴结清扫术，未见手术并发症显著升高。提示：术前准确估计期别是影响手术治疗的重要因素，对包括腺癌的Ｉｂ期病例手术时可予保留卵巢，老年妇女并非为根治术的绝对禁忌证。     

The incidence and clinical significance of paraaortic lymph node metastases in patients with uterine cervical cancer

Paraaortic lymph node dissection was performed in the treatment of patients with carcinoma of the cervix who were subjected to radical hysterectomy between June, 1982 and March, 1988 at the Department of Obstetrics and Gynecology, Hokkaido University Hospital, Sapporo, Japan. Thirteen out of 246 (5.3%) patients had metastases in the paraaortic lymph node. Of the patients with stage I carcinoma of the cervix, 1.0 per cent had positive paraaortic lymph node. Of the patients with stage II carcinoma, 4.9 per cent had metastases in the paraaortic lymph nodes, and of the stage III patients, 16.7 per cent had positive paraaortic lymph nodes. The incidence of paraaortic node involvement increased along with the advance of the disease. Of the patients with squamous cell carcinoma of the cervix, 4.6 per cent had paraaortic lymph node metastases. Of the patients with adenocarcinoma of the cervix including mixed carcinoma, 6.8 per cent had positive paraaortic node. All the patients with positive paraaortic lymph nodes had metastatic diseases in the pelvic nodes. In addition, the number of groups of positive pelvic nodes in the patients with positive paraaortic lymph nodes was significantly larger than that in those with negative paraaortic nodes. At the time of reporting, seven out of 13 patients with positive paraaortic lymph node have died of the disease. The mean survival period of those seven patients was 14.9 +/- 12.2 (mean +/- SD) months. Of the remaining six surviving patients, three have been doing well for more than three years.(ABSTRACT TRUNCATED AT 250 WORDS)     

Primary radical surgery in carcinoma of the cervix uteri

Fifty patients with cervical carcinoma were treated by primary radical hysterectomy and transperitoneal pelvic lymphadenectomy by one surgeon and followed 10 to 20 years. Of 15 patients with pelvic lymph node metastases 10 received postoperative irradiation of whom 7 developed recurrence and died from cancer. Of 5 patients with metastases who did not receive radiotherapy, 3 developed recurrence: 1 with distant metastases died. The other 2 with localized recurrences were treated with radiotherapy and survived more than 9 years. The 5- and 10-year observed survival rates for stage I b patients were 85% and 76% respectively.     

Results of radical surgical procedures after radiation for treatment of invasive carcinoma of the uterine cervix in a private practice

An analysis is made of the results of treatment of 96 women with carcinoma of the cervix, Stages IB and II, in a private practive. All 96 women were treated preoperatively with uterine intracavitary radium, followed 6 weeks later by Wertheim hysterectomy with pelvic lymphadenectomy. If malignant tumor was present in the lateral pelvic lymph nodes, external radiation was given postoperatively. The over-all survival rates were: Stage IB, 88% and 84% at 5 and 10 years; Stage II, 72% and 62% at 5 and 10 years. Regardles of the clinical stage, the highest survival rates were found in those patients who had no malignancy in the lateral pelvic lymph nodes and no residual cervical carcinoma. The lowest survical rates were found in those patients who had both residual cervical carcinoma and lymph node metastases.     

The influence of selected prognostic factors on the results of combined treatment of invasive carcinoma of the cervix on stage IB and stage IIA

This is a retrospective analysis of 180 patients treated by combination of radical surgery and radiotherapy for invasive carcinoma of the cervix in stage IB and IIA. The influence of the following prognostic factors on the survival has been evaluated: the presence of pelvic lymph node metastases, histopathology of the tumor, the size of the primary tumor, presence of vascular space invasion and surgical margines. Nodal status has proved to be the most important prognostic factor: 91% of patients without pelvic lymph node metastases survived 5 years, 57% with up to two metastases and 36% with three and more metastases to the pelvic nodes. A significantly worse prognosis has also been observed in patients with adenocarcinoma of the cervix, and with the size of the tumor of more than 2 cm.     

Adjuvant combined paclitaxel and carboplatin chemotherapy for glassy cell carcinoma of the uterine cervix: report of three cases with clinicopathological analysis

Glassy cell carcinoma of the uterine cervix (GCC) is a rare form of cervical carcinoma that is characterized by aggressiveness and poor prognosis. We reviewed a variety of clinicopathological features, treatment strategies, and outcomes in three women with GCC. The three patients were successfully treated by radical hysterectomy with pelvic/para-aortic lymphadenectomy. The patients had stage Ib1, stage IIa, and stage Ib2 tumors without lymph node metastases. A 44-year-old woman with stage Ib1 tumor did not undergo adjuvant chemotherapy or radiation therapy. She had recurrent pelvic tumors 12 months after surgery, and died 6 months after the recurrent disease. The histological findings of her cervix, which were different from the other two patients, did not show the marked infiltration of eosinophils. The other two patients with stage Ib2 and IIa tumors underwent adjuvant chemotherapy with paclitaxel and carboplatin, and had disease-free survival for 4.5 and 9 years. We think that all patients with GCC of stage Ib1 or more should undergo adjuvant chemotherapy of paclitaxel and carboplatin or other adjuvant therapies.     

Angiographic evaluation of early carcinoma of the cervix

The ability of pelvic angiography to detect occult cervical carcinoma metastases is evaluated. Twenty-five patients with invasive squamous cell carcinoma had pretreatment lymphangiograms. Seventeen Stage I patients received operative therapy. Four Stage I patients had abnormal angiographic blushes. Only enlarged lymph nodes with no metastatic carcinoma were found in these areas. Three patients with histologically proven metastases had no angiographic evidence of tumor spread. In six patients with clinical Stage II or III carcinoma, only one patient had angiographic evidence of tumor spread from the cervix. Thus, angiography does not reliably document or exclude the presence of occult cervical metastases.     

Small cell neuroendocrine carcinoma of the cervix with involvement of multiple pelvic nodes--A successfully treated case by multimodal approach

Small cell neuroendocrine carcinoma of the cervix is very rare and is usually associated with dismal prognosis if treated by conventional surgery and radiotherapy even in early stage disease. This tumor is characterized by early lymphatic and hematogenous spread. Only one successfully treated case of small cell neuroendocrine carcinoma of the cervix with dissemination to the pelvic nodes had been reported before in the literature. We are reporting a case of small cell neuroendocrine carcinoma of the cervix with multiple pelvic nodal metastases including the common iliac nodes, which had been successfully treated with a multimodal approach including radical hysterectomy, pelvic/para-aortic lymphadenectomy, and postoperative chemotherapy using cisplatin-etoposide combinations and pelvic irradiation.     

Stromal invasion of the cervix can be excluded from the criteria for using adjuvant radiotherapy following radical surgery for patients with cervical cancer

BACKGROUND: Regarding complications of radiotherapy, the indications for adjuvant radiotherapy should be restricted. We conducted the present study to determine whether deep stromal invasion of the cervix could be excluded from the criteria used to identify patients for this treatment surgery. METHODS: This study included 115 patients with FIGO stage Ib to IIb cervical cancer who underwent radical hysterectomy and pelvic lymph node dissection. Patients had the following tumors: 61 nonkeratinizing squamous cell carcinoma, 21 keratinizing squamous cell carcinoma, 26 adenocarcinoma, and 7 adenosquamous cell carcinoma. Our study criteria for using adjuvant radiotherapy included positive lymph node involvement, a compromised surgical margin, or parametrial extension. Deep stromal invasion of the cervix was excluded from the criteria in this study. RESULTS: Seventy-two of the 115 patients (62.6%) underwent radical surgery only and all were alive. The remaining 43 patients received a complete course of external irradiation following radical surgery. The estimated 5-year survival rate is 100% for patients with stage Ib, 93.3% for stage IIa, and 52.7% for stage IIb. Fifty-five patients (47.8%) had deep stromal invasion. The prognosis for patients with deep stromal invasion was significantly worse than that for patients without deep stromal invasion (5-year survival rate, 69.8% vs. 98.0%). However, 21 patients (18.3%) with deep stromal invasion, but without positive lymph node involvement, compromised surgical margin, or parametrial extension, were alive without recurrence. Multivariate analysis showed that lymph node involvement and parametrial extension were independent prognostic factors, but that deep stromal invasion was not. CONCLUSION: Deep stromal invasion of the cervix can be excluded from the list of criteria for selecting patients with cervical cancer who would benefit from adjuvant radiotherapy following radical surgery.     

Prognostic value of p53 expression in stage IB1 cervical carcinoma

The purpose of this retrospective study was to evaluate the patterns of p53 expression in stage IB1 squamous cell carcinoma of the uterine cervix, to compare p53 expression with clinicopathological findings, and to assess its prognostic value. 27 patients with stage IB1 squamous cell carcinoma of the uterine cervix underwent abdominal radical hysterectomy and pelvic lymph node dissection. Expression of p53 was studied immunohistochemically. Overexpression of p53 was detected in 33.3% of the tumors, low expression was seen in 11.1%, and negative expression was found in 55.6%. Deep cervical stromal invasion (> or = 1/2) was found to be associated with the increased risk of lymph node metastases (odds ratio = 17.5). A significantly lower percentage of patients survived when p53 overexpression was observed (p = 0.0315). Univariate analysis revealed that tumor size (2-3.9 cm), lymph node metastasis, tumor invasion into parametria, tumor invasion into blood/lymph vessels, squamous cell carcinoma antigen (> or = 2 ng/ml), and p53 overexpression had a significantly lower recurrence-free survival rate. None of these above factors obtained significance in the multivariate analysis. This study suggests that expression of p53 may be indicative of an unfavorable prognosis in patients with stage IB1 squamous cell carcinoma of the uterine cervix.     

Prognostic factors in FIGO stage IB cervical cancer without lymph node metastasis and the role of adjuvant radiotherapy after radical hysterectomy

OBJECTIVES: The aim of this study was to evaluate the clinical and pathologic prognostic variables for disease free survival, overall survival and the role of adjuvant radiotherapy in FIGO stage IB cervical carcinoma without lymph node metastasis. METHODS: A retrospective review was performed of 393 patients with lymph node negative stage IB cervical cancer treated by type 3 hysterectomy and pelvic lymphadenectomy at the Hacettepe University Hospitals between 1980 and 1997. RESULTS: The disease free survival and overall survival were 87.6 and 91.0%, respectively. In univariate analysis, tumor size, depth of invasion, vaginal involvement, lympho-vascular space involvement (LVSI) and adjuvant radiotherapy were found significant in disease free survival. Overall survival was affected by tumor size, LVSI, vaginal involvement and adjuvant radiotherapy. Tumor size, LVSI and vaginal involvement were found as independent prognostic factors for overall and disease free survival in multivariate analysis. Disease free survival, recurrence rate and site did not differ between patients underwent radical surgery and radical surgery plus radiotherapy. CONCLUSION: Tumor size, LVSI and vaginal involvement were independent prognostic factors in lymph node negative FIGO stage IB cervical cancer. Adjuvant radiotherapy in stage IB cervical cancer patients with negative nodes provides no survival advantage or better local tumoral control.