| 摘要: |
| ［摘要］ 目的 分析宫颈透明细胞腺癌（CCAC）患者的临床与病理特征，以期为该罕见肿瘤的临床诊疗提供参考。方法 回顾性分析甘肃省妇幼保健院（甘肃省中心医院）2020年1月至2023年3月诊治的9例CCAC患者的临床表现、组织学特征、免疫组化结果、治疗方案及预后情况。结果 9例患者中位年龄为64.0岁。其中绝经后阴道出血6例，接触性出血2例，子宫肌瘤行子宫次全切除后阴道出血1例。人乳头瘤病毒（HPV）检测阴性者8例；国际妇产科联盟（FIGO）分期：ⅠB2期4例，ⅡA1期2例，ⅡA2期1例，ⅢC1p期1例，ⅢC2r期1例。8例患者行手术治疗；1例分期为FIGO ⅢC2r期的患者未手术，进行放化疗。7例行开腹广泛性子宫切除术+双侧附件切除术+盆腔淋巴结清扫术（其中2例同时行腹主动脉旁淋巴结清扫术，1例同时行大网膜切除术），1例曾行子宫次全切除术患者行开腹广泛性宫颈切除术+双侧附件切除术+盆腔淋巴结清扫术+腹主动脉旁淋巴结清扫术。免疫组化结果：p16阳性（8/9），配对盒8（PAX8）阳性（5/5），天冬氨酸蛋白酶A（Napsin A）阳性（5/8），肝细胞核因子-1β（HNF-1β）阳性（5/5）。中位随访时间25个月，总生存期为16～52个月。结论 研究提示CCAC好发于中老年人群，且CCAC与HPV感染无显著关联。其临床特征缺乏特异性，目前尚无有效的CCAC筛查方法，需开展更深入的研究以改善CCAC的预后。 |
| 关键词: 宫颈透明细胞癌 临床病理特征 诊断 预后 |
| DOI：10.3969/j.issn.1674-3806.2026.08.05 |
| 分类号:R 737.33 |
| 基金项目:甘肃省自然科学基金项目（编号：22JR11RA179）；甘肃省联合科研基金一般项目（编号：24JRRA935） |
|
| Cervical clear cell adenocarcinoma: clinical and pathological analysis of 9 cases |
|
Wan Tao1, Wei Ying1, Zhang Yaqing1, Zhang Dengcai2, Tuo Shumei1, Wang Li3, Zhou Haiyan1, Lu Yongli1, Liu Haiyan1, Lu Yun1, Liu Qing1, Dang Yun1,4
|
|
1.The Second Department of Gynecologic Oncology, Gansu Provincial Maternity and Child-Care Hospital(Gansu Provincial Central Hospital), Lanzhou 730070, China; 2.Department of Pathology, Gansu Provincial Maternity and Child-Care Hospital(Gansu Provincial Central Hospital), Lanzhou 730070, China; 3.Department of Gynecology, Shandan County Maternal and Child Health Hospital, Zhangye 734100, China; 4.Institute of Pathology, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
|
| Abstract: |
| ［Abstract］ Objective To analyze the clinical and pathological features of patients with cervical clear cell adenocarcinoma(CCAC), aiming to provide evidence-based reference for the clinical diagnosis and treatment of this rare tumor. Methods A retrospective analysis was conducted on the clinical manifestations, histological features, immunohistochemical results, treatment regimens and prognoses of 9 patients with CCAC who were diagnosed and treated at Gansu Provincial Maternity and Child-Care Hospital(Gansu Provincial Central Hospital) from January 2020 to March 2023. Results The median age of the 9 patients was 64.0 years. Their clinical presentations included postmenopausal vaginal bleeding in 6 patients, contact bleeding in 2 patients, and vaginal bleeding following subtotal hysterectomy for uterine fibroids in 1 patient. Human papillomavirus(HPV) testing was negative in 8 patients. The International Federation of Gynecology and Obstetrics(FIGO) stages of the 9 patients were as follows: stage ⅠB2 in 4 patients, stage ⅡA1 in 2 patients, stage ⅡA2 in 1 patient, stage ⅢC1p in 1 patient, and stage ⅢC2r in 1 patient. Among the 9 patients, 8 patients underwent surgical treatment, and 1 patient with FIGO stage ⅢC2r received chemoradiotherapy without surgery. Seven patients underwent abdominal radical hysterectomy+bilateral salpingo-oophorectomy+pelvic lymphadenectomy, among whom 2 also underwent para-aortic lymphadenectomy and 1 also underwent omentectomy. One patient who had previously undergone subtotal hysterectomy received abdominal radical trachelectomy+bilateral salpingo-oophorectomy+pelvic lymphadenectomy+para-aortic lymphadenectomy. Immunohistochemical results: among the 9 patients tested, 8 were positive for p16(8/9); among the 5 patients tested, all 5 were positive for paired box 8(PAX8)(5/5); among the 8 patients tested, 5 were positive for aspartic proteinase A(Napsin A)(5/8); and among the 5 patients tested, all 5 were positive for hepatocyte nuclear factor-1 beta(HNF-1β)(5/5). The median follow-up period was 25 months, with overall survival(OS) ranging from 16 to 52 months. Conclusion This study suggests that CCAC predominantly occurs in middle-aged and elderly populations, and that CCAC is not significantly associated with HPV infection. The clinical features of CCAC lack specificity, and there are currently no effective screening methods for CCAC. Further in-depth studies are warranted to improve the prognosis of CCAC. |
| Key words: cervical clear cell adenocarcinoma(CCAC) clinical and pathological features diagnosis prognosis |
