宫颈小细胞神经内分泌癌一例并文献复习

doi:10.12280/gjszjk.20230139

摘要/Abstract

摘要：

宫颈小细胞神经内分泌癌（small cell neuroendocrine carcinoma of the cervix，SCNCC）早期易发生淋巴转移，病理表现独特，易复发，预后差。报告1例SCNCC ⅢC1r期病例资料，患者因间断性阴道出血伴下腹痛1个月余就诊，结合盆腔磁共振成像、全腹CT及宫腔镜活检结果诊断为SCNCCⅢC1r期，根据2022年美国国立综合癌症网络（National Comprehensive Cancer Network，NCCN）指南，结合该患者病情，给予患者3个周期的卡铂+依托泊苷新辅助化疗，后行腹腔镜下广泛性子宫切除术+双侧卵巢切除术+双侧输卵管切除术+盆腔淋巴结清扫术+腹主动脉旁淋巴结切除术+抗肿瘤药物腹腔灌注治疗（奈达铂冲洗腹腔）+双侧输尿管支架植入术，术后继续化疗3个周期，术后随访13个月未见复发。

关键词: 癌，神经内分泌, 癌，小细胞, 宫颈肿瘤, 影像引导活检, 病例报告

Abstract:

Small cell neuroendocrine carcinoma of the cervix (SCNCC) is prone to lymphatic metastasis in the early stage, unique pathological manifestations, easy to recur, and poor prognosis. Data from one case of SCNCC (stage ⅢC1r) is reported. The patient presented with intermittent vaginal bleeding with lower abdominal pain for more than 1 month. Combined with the results of pelvic magnetic resonanace imaging (MRI), total abdominal CT and hysteroscopy with endometrial biopsy, it was diagnosed as SCNCC at ⅢC1r stage. According to the 2022 National Comprehensive Cancer Network (NCCN) guidelines, the patient was given 3 cycles of neoadjuvant chemotherapy (carboplatin plus etoposide neoadjuvant), followed by laparoscopic extensive hysterectomy plus bilateral oophorectomy plus bilateral salpingectomy plus pelvic lymph node dissection plus abdominal para-aortic lymphadenectomy plus antitumor drug intraperitoneal perfusion therapy (nidaplatin flushing the abdominal cavity) plus bilateral ureteral stent implantation. After surgery, the patient was given 3 cycles of chemotherapy again. No recurrence was seen in 13 months of postoperative follow-up.

Key words: Carcinoma, neuroendocrine, Carcinoma, small cell, Uterine cervical neoplasms, Image-guided biopsy, Case reports

张婷婷, 王黎, 俞萍源, 陈曦, 杨永秀. 宫颈小细胞神经内分泌癌一例并文献复习[J]. 国际生殖健康/计划生育杂志, 2023, 42(6): 462-466.

ZHANG Ting-ting, WANG Li, YU Ping-yuan, CHEN Xi, YANG Yong-xiu. Small Cell Neuroendocrine Carcinoma of the Cervix: A Case Report and Literature Review[J]. Journal of International Reproductive Health/Family Planning, 2023, 42(6): 462-466.

图/表 3

图1 全腹CT平扫+增强图注：A 动脉期（宫体），B 静脉期（宫体），C 延迟期（宫体），D 动脉期（宫颈），E 静脉期（宫颈），F 延迟期（宫颈）。A、B、C中可见子宫体积增大，子宫壁不均匀增厚，并多发大小不等结节向腔内突起（如箭头所示），增强可见明显强化，宫腔内可见积液。D、E、F中可见宫颈明显肥厚并多发强化结节影（如箭头所示）。

图2 患者新辅助化疗前后盆腔MRI图注：A 新辅助化疗前盆腔MRI图，B 新辅助化疗3个周期后盆腔MRI图。A中可见子宫形态失常，体积增大，T2加权成像（T2WI）示子宫内膜弥漫不均匀增厚并内生结节及团块影（长箭头所示），宫腔增大、积液，宫底、宫体及宫颈部结合带、宫底肌层及外膜T2WI信号异常并多发结节及团块影（短箭头所示）。予以3个周期新辅助化疗后，B中可见子宫形态较前正常，体积较前明显缩小，子宫内膜不均匀增厚较前明显减轻，多发内生异常信号肿物较前未见明确显示（长箭头所示），宫颈部结合带多发结节及团块影较前未见明确显示（短箭头所示）。

图3 SCNCC治疗原则[5]

参考文献 14

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