Clinicopathological Analysis of Nine Cases of Cervical Gastric-Type Adenocarcinoma

doi:10.12280/gjszjk.20210353

Abstract

Abstract:

Objective: To analyze the clinical and pathological characteristics of gastric-type adenocarcinoma (GAS), in order to diagnose and treat the disease early and improve the prognosis. Methods: The diagnosis, treatment, follow-up, pathological morphology, immunohistochemical characteristics and other data of 9 cases of cervical GAS in Tianjin Central Hospital of Gynecology Obstetrics from July 2013 to July 2017 were retrospectively analyzed, and relevant literatures were reviewed. Results: The median age of 9 patients was 44 years old. 6 patients were diagnosed in pre-operation, 2 in intra-operation and 1 was in post-operation. There were 3 cases of long-term abnormal vaginal discharge, 2 cases of intrauterine fluid and 5 cases of ovarian mass. The mean overall time to survival was 104.3 months (95%CI: 66.6-142.1 months). The survival rates at 12 months, 24 months and 36 months were 88.9%, 77.8% and 66.7% respectively. The cervical GAS mainly invaded towards the uterine body. The pathological microscope showed little difference from the normal gland. Immunohistochemical analysis of HIK1083, Mucin 6 (MUC6), cytokeratin7 (CK7), CDX2, villin, paired box gene-8 (PAX-8), CA-125, CA-19-9, P16 and carcinoembryonic antigen (CEA) showed high positive rates, while the positive rates of CK20, PAX-2 and P53 were low. Conclusions: Cervical GAS is rare and easy to be misdiagnosed. However, through the multidisciplinary combination of clinical, imaging and pathology, there is an opportunity to achieve the early diagnosis and treatment of GAS and improve the survival expectation.

Key words: Uterine cervical neoplasms, Adenocarcinoma, mucinous, Immunohistochemistry, Diagnosis, Prognosis, Minimal deviation adenocarcinoma

AN Chong-you, MA Yao-mei. Clinicopathological Analysis of Nine Cases of Cervical Gastric-Type Adenocarcinoma[J]. Journal of International Reproductive Health/Family Planning, 2021, 40(5): 377-381.

Figures/Tables 7

References 13

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序号	发病年龄（岁）	期别	临床表现	HPV检测结果	确诊标本来源	特殊辅助检查	手术方式	化疗	放疗	随访终点及生存时间（个月）
1	30	Ⅳ	盆腔肿物伴宫腔积液	阴性	术后病理	PET提示双卵巢恶性肿瘤	全子宫+双附件+大网膜、阑尾切除	是	否	DOD（10）
2	42	Ⅰb1	阴道排液1年	阴性	锥切病理	MR提示宫颈恶性肿瘤	宫颈癌根治术+双附件切除	是	是	NED（83）
3	66	Ⅱb	绝经后阴道出血伴盆腔肿物	阴性	宫颈活检	-	宫颈癌根治术+双附件切除	是	否	ND（35）
4	51	Ⅰb1	阴道排液8年伴盆腔肿物	阴性	宫腔镜下宫颈活检	MR多次提示宫颈恶性肿瘤	宫颈癌根治术+双附件切除	是	是	NED（59）
5	49	Ⅳ	右附件肿物	阴性	术中快速病理	MR提示卵巢恶性肿瘤,宫颈黏膜增厚	宫颈癌根治术+双附件切除+大网膜、阑尾、腹主动脉旁淋巴结切除	是	是	NED（59）
6	44	Ⅰb2	接触性出血2个月	阴性	宫颈活检	-	筋膜外全子宫+左附件、右输卵管切除	是*	是	DOD（24）
7	31	Ⅰb2	阴道排液9年,P-J综合征,肠套叠史	阴性	宫颈活检	MR考虑宫颈微偏腺癌可能	宫颈癌根治术+双附件切除	是	是	NED（55）
8	48	Ⅱa	子宫体肿物伴宫腔积液	阴性	宫颈活检	TCT提示不典型腺细胞	宫颈癌根治术+双附件、阑尾切除术	是	是	NED（74）
9	44	Ⅰb2	宫颈后唇团块	阴性	术中快速病理	-	宫颈癌根治术+双附件切除	是	否	NED（145）

序号	发病年龄（岁）	期别	临床表现	HPV检测结果	确诊标本来源	特殊辅助检查	手术方式	化疗	放疗	随访终点及生存时间（个月）
1	30	Ⅳ	盆腔肿物伴宫腔积液	阴性	术后病理	PET提示双卵巢恶性肿瘤	全子宫+双附件+大网膜、阑尾切除	是	否	DOD（10）
2	42	Ⅰb1	阴道排液1年	阴性	锥切病理	MR提示宫颈恶性肿瘤	宫颈癌根治术+双附件切除	是	是	NED（83）
3	66	Ⅱb	绝经后阴道出血伴盆腔肿物	阴性	宫颈活检	-	宫颈癌根治术+双附件切除	是	否	ND（35）
4	51	Ⅰb1	阴道排液8年伴盆腔肿物	阴性	宫腔镜下宫颈活检	MR多次提示宫颈恶性肿瘤	宫颈癌根治术+双附件切除	是	是	NED（59）
5	49	Ⅳ	右附件肿物	阴性	术中快速病理	MR提示卵巢恶性肿瘤,宫颈黏膜增厚	宫颈癌根治术+双附件切除+大网膜、阑尾、腹主动脉旁淋巴结切除	是	是	NED（59）
6	44	Ⅰb2	接触性出血2个月	阴性	宫颈活检	-	筋膜外全子宫+左附件、右输卵管切除	是*	是	DOD（24）
7	31	Ⅰb2	阴道排液9年,P-J综合征,肠套叠史	阴性	宫颈活检	MR考虑宫颈微偏腺癌可能	宫颈癌根治术+双附件切除	是	是	NED（55）
8	48	Ⅱa	子宫体肿物伴宫腔积液	阴性	宫颈活检	TCT提示不典型腺细胞	宫颈癌根治术+双附件、阑尾切除术	是	是	NED（74）
9	44	Ⅰb2	宫颈后唇团块	阴性	术中快速病理	-	宫颈癌根治术+双附件切除	是	否	NED（145）

序号	侵犯宽度	侵肌深度	宫旁侵犯	阴道受累	宫体受累	脉管癌栓	淋巴转移	远行转移
1	宫颈全周	全层	有	无	无	有	有	有
2	宫颈全周	>1/2肌层	无	无	有	无	无	无
3	宫颈全周	全层	有	有	有	有	有	无
4	1/3全周	>1/2肌层	无	无	无	无	无	无
5	宫颈全周	>2/3肌层	有	无	有	有	无	有
6*	宫颈全周	近全层**	无	无	有	无	-	无
7	宫颈全周	>2/3肌层	无	无	无	无	无	无
8	宫颈全周	全层	无	有	有	无	有	无
9	宫颈全周	>1/2肌层	无	无	无	无	无	无

序号	侵犯宽度	侵肌深度	宫旁侵犯	阴道受累	宫体受累	脉管癌栓	淋巴转移	远行转移
1	宫颈全周	全层	有	无	无	有	有	有
2	宫颈全周	>1/2肌层	无	无	有	无	无	无
3	宫颈全周	全层	有	有	有	有	有	无
4	1/3全周	>1/2肌层	无	无	无	无	无	无
5	宫颈全周	>2/3肌层	有	无	有	有	无	有
6*	宫颈全周	近全层**	无	无	有	无	-	无
7	宫颈全周	>2/3肌层	无	无	无	无	无	无
8	宫颈全周	全层	无	有	有	无	有	无
9	宫颈全周	>1/2肌层	无	无	无	无	无	无

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