子宫颈鳞状移行细胞癌临床病理分析

目的 分析子宫颈鳞状移行细胞癌（squamotransitional cell carcinoma，STCC）的临床、病理及免疫组化表达特征，探讨STCC的诊断和鉴别诊断及细胞分化。方法 参照2003年WHO子宫颈肿瘤组织学分类，对8例STCC进行临床病理形态学观察和免疫组化检测。结果 患者平均年龄37．1岁（28～54岁），临床表现为接触性阴道出血，部分病例白带有异味，病程1个月～5年。子宫颈肥大呈粗颗粒状或微绒状，部分病例（2／8）见息肉或菜花样新生物。所有病例均见乳头状结构，乳头由多层异型鳞状细胞样或移行细胞样上皮覆盖，细胞无挖空特征，乳头内为纤维血管中心柱；大部分乳头为非浸润性，2例为浸润性，2例子宫颈壁有深部浸润的表面乳头中见厚壁血管。所有病例均见程度不等的子宫颈间质浸润（0．1cm至全层），HE切片下判断4例有脉管内浸润，1例盆腔淋巴结有转移。免疫组化染色显示p16均呈强阳性表达，CK7、CK14、CK19呈不同程度阳性表达，CK20仅在2例见局灶阳性，在D2-40标记下发现6例有淋巴管浸润。结论 STCC是一种具有独立形态学特征的子宫颈恶性肿瘤，有别于子宫颈普通鳞癌及其他呈乳头状生长的恶性肿瘤如疣性癌、疣状癌等；尽管大部分乳头为非浸润性，STCC易向子宫颈壁浸润的特点提示深部活检明确诊断的必要性，乳头内厚壁血管可能与深部浸润有关；免疫组化结果提示STCC属鳞状细胞癌，不支持有真正的移行细胞分化。STCC与高危型HPV感染有关，易经淋巴道转移。

Clinicopathologic analysis of cervical squamotransitional cell carcinoma

Purpose To study the clinicopathological and immunohistochemistry (IHC) expression features of cervical squamotransitional cell carcinoma (STCC), and to explore the diagnosis, differential diagnosis and cell differentiation of STCC.Methods Cases of STCC were selected according to WHO classification of cervical tumors (2003). The clinicopathological features were observed, and all cases were detected by IHC for CK7, CK14, CK19, CK20, p16 and D2-40. Results The patients ranged in age from 28 to 54 years (mean 37.1). The common clinical presentation was abnormal bleeding. Some cases had bad smell discharge. The course of disease ranged from 1 month to 5 years. Lesions were grossly presented as coarse granular, micropapillary, polypoid or cauliflower-like neoplasm. All cases demonstrated papillary structures with fibrovascular cords lined by multi-layered and atypical epithelia, which were composed of both squamous cell and transitional cell-like cell, devoid of koilocytic features. The majority of papillae were noninvasive, invasive papillae could be seen in 2 cases. In 2 deep stromal invasion cases, thick-wall vessels could be observed in papillary. All cases had stromal invasion ranged in depth from 0.1 cm to whole cervical wall. 4 cases had vascular invasion in HE staining. 1 case had pelvic lymph node metastasis. Immunohistochemically, all cases showed strongly positive for p16 , mildly to strongly positive for CK7, CK14 and CK19. Only 2 cases showed focally positive for CK20. Guided by D2-40 marker, 6 cases showed lymphatic invasion. Conclusions STCC is a cervical malignant tumor that has distinct morphologic features, and it should be differentiated from common cervical squamous carcinoma and its other variants with papillary features including verrucous, condylomatous carcinoma. Although the majority of papillae are noninvasive, the propensity to stromal invasion of STCC suggests the necessity of deep biopsy to make a correct diagnosis. The thick wall vessels in papillae may be corrective with the degree of stromal invasion. The results of IHC suggest STCC derives from cervical squamous epithelium. It lacks true transitional cell differentiation. STCC has a strong association with high risk HPV infection, and easy to metastasize by lymphatic space.