宫颈高级别鳞状上皮内病变累及子宫内膜、卵巢一例并文献复习

doi:10.12280/gjfckx.20220515

摘要/Abstract

摘要：

宫颈鳞状细胞癌以浅表扩散的方式累及子宫内膜表面较为罕见，目前仍缺乏针对性的临床诊疗指导。报道1例60岁女性，因绝经后异常阴道流液就诊于我院，人乳头瘤病毒16阳性，后行腹腔镜全子宫+双侧附件切除术，术后病理结果示：宫颈高级别鳞状上皮内病变累及腺体，广泛浅表蔓延至子宫内膜，并累及右侧卵巢浆膜面，且3处病灶呈现p16及Ki-67的一致性高表达。对既往文献报道及本病例特点进行归纳总结，以期为疾病的早期诊治提供依据，改善临床预后。

关键词: 宫颈肿瘤, 癌, 鳞状细胞, 子宫内膜, 卵巢, 乳头状瘤病毒科, 病例报告

Abstract:

Cervical squamous cell carcinoma that spreads superficially to the inner surface of the endometrium has been rarely reported. There is still lack of clinical guidance for this disease entity. In this paper, we report a case of a 60-year-old woman who presented to our hospital with "abnormal postmenopausal vaginal discharge" and was positive for human papillomavirus 16, followed by laparoscopic total hysterectomy and bilateral salpingo-oophorectomy. Postoperative pathological findings showed that the high-grade squamous intraepithelial lesions of the cervix involved the glands and spread widely superficially to the endometrium and involved the plasma surface of the right ovary. All the lesions showed consistent high expression of p16 and Ki-67. We summarize the previous reports and the characteristics of this case in order to provide evidence for early diagnosis and treatment of the disease and improve clinical prognosis.

Key words: Uterine cervical neoplasms, Carcinoma, squamous cell, Endometrium, Ovary, Papillomaviridae, Case reports

陈至柔, 王新焘, 胡群超, 诸海燕. 宫颈高级别鳞状上皮内病变累及子宫内膜、卵巢一例并文献复习[J]. 国际妇产科学杂志, 2023, 50(2): 237-240.

CHEN Zhi-rou, WANG Xin-tao, HU Qun-chao, ZHU Hai-yan. Cervical High-Grade Squamous Intraepithelial Lesions Involving the Endometrium and Ovary: A Case Report and Literature Review[J]. Journal of International Obstetrics and Gynecology, 2023, 50(2): 237-240.

图/表 3

图1 全子宫+双侧附件切除术后病理图（HE染色×10）注：A 宫颈组织切片；B 子宫内膜组织切片；C 右侧卵巢组织切片。红圈内深染部位为肿瘤病灶。

图2 全子宫+双侧附件切除术后组织免疫组织化学图（Ki-67免疫组织化学染色×10）注：A 宫颈组织切片，Ki-67（80%+）；B 子宫内膜组织切片，Ki-67（80%+）；C 右侧卵巢组织切片，Ki-67（30%+）。红圈内深染部位为肿瘤病灶。

图3 全子宫+双侧附件切除术后组织免疫组织化学图（p16免疫组织化学染色×10）注：A 宫颈组织切片，p16（弥漫强+）；B 子宫内膜组织切片，p16（弥漫强+）；C 右侧卵巢组织切片，p16（弥漫强+）。红圈内深染部位为肿瘤病灶。

参考文献 29

[1]	Du J, Liao X. Superficial spreading squamous cell carcinoma in situ of the cervix involving the endometrium: a rare case presentation and review of literature[J]. Int J Clin Exp Pathol, 2019, 12(11):4162-4166.
[2]	Ishida M, Okabe H. Superficial spreading squamous cell carcinoma of the uterine cervix involving the endometrium: Report of two cases with emphasis on the likely molecular mechanism[J]. Oncol Lett, 2013, 5(1):31-34. doi: 10.3892/ol.2012.953. doi: 10.3892/ol.2012.953 pmid: 23255888
[3]	中国抗癌协会妇科肿瘤专业委员会. 子宫颈癌诊断与治疗指南(2021年版)[J]. 中国癌症杂志, 2021, 31(6):474-489. doi: 10.19401/j.cnki.1007-3639.2021.06.06. doi: 10.19401/j.cnki.1007-3639.2021.06.06
[4]	周晖, 王东雁, 罗铭, 等. 《FIGO 2021妇癌报告》——子宫颈癌指南解读[J]. 中国实用妇科与产科杂志, 2022, 38(5):538-544. doi: 10.19538/j.fk2022050114. doi: 10.19538/j.fk2022050114
[5]	Ferenczy A, Richart RM, Okagaki T. Endometrial involvement by cervical carcinoma in situ[J]. Am J Obstet Gynecol, 1971, 110(4):590-592. doi: 10.1016/0002-9378(71)90706-x. doi: 10.1016/0002-9378(71)90706-x pmid: 5582013
[6]	Wang W, Zhou F. Cervical HSIL Involving the Endometrium and Adenomyosis: A Case Report and Literature Review[J]. J Coll Physicians Surg Pak, 2021, 31(3):337-339. doi: 10.29271/jcpsp.2021.03.337. doi: 10.29271/jcpsp.2021.03.337
[7]	Nakajima T, Hatta H, Nishida T, et al. Superficial spread of cervical squamous cell carcinoma to the upper genital tract and dissemination to the omentum[J]. Pathol Int, 2019, 69(2):119-121. doi: 10.1111/pin.12754. doi: 10.1111/pin.12754 pmid: 30694584
[8]	Muthusamy RK, Mehta SS. Squamous Cell Carcinoma In situ of the Cervix with Superficial Intraepithelial Extension to the Endometrium of Lower Uterine Segment: A Rare Presentation[J]. Indian J Med Paediatr Oncol, 2017, 38(1):88-89. doi: 10.4103/0971-5851.203509. doi: 10.4103/0971-5851.203509
[9]	Anthuenis J, Baekelandt J, Bourgain C, et al. Squamous cell carcinoma in situ lining the uterine cavity[J]. Eur J Gynaecol Oncol, 2016, 37(1):135-138. pmid: 27048127
[10]	Chao A, Wang AM, Wang TH, et al. An atypical and fatal case of pyometra accompanied by the superficial spread of squamous cell carcinoma of the endometrium and the fallopian tubes[J]. Taiwan J Obstet Gynecol, 2013, 52(3):440-442. doi: 10.1016/j.tjog.2013.05.004. doi: 10.1016/j.tjog.2013.05.004 pmid: 24075391
[11]	Marwah N, Garg M, Singh S, et al. Unusual form of squamous cell carcinoma of the cervix extending in situ into the endometrium: Three case reports and review of literature[J]. Int J Appl Basic Med Res, 2012, 2(2):139-141. doi: 10.4103/2229-516X.106359. doi: 10.4103/2229-516X.106359 pmid: 23776829
[12]	Kushima M, Fujii H, Murakami K, et al. Simultaneous squamous cell carcinomas of the uterine cervix and upper genital tract: loss of heterozygosity analysis demonstrates clonal neoplasms of cervical origin[J]. Int J Gynecol Pathol, 2001, 20(4):353-358. doi: 10.1097/00004347-200110000-00007. doi: 10.1097/00004347-200110000-00007 pmid: 11603219
[13]	Gupta S, Gupta IM, Tiwari PV. In-situ carcinoma of the uterine cervix showing superficial endometrial spread[J]. Acta Obstet Gynecol Scand, 1979, 58(5):507-508. doi: 10.3109/00016347909154079. doi: 10.3109/00016347909154079
[14]	Razquin S, Mayayo E, Antón E, et al. Squamous cell carcinoma in situ of the endometrium as superficial extension of cervical carcinoma[J]. Gynecol Obstet Invest, 1993, 35(3):190-192. doi: 10.1159/000292698. doi: 10.1159/000292698
[15]	Pins MR, Young RH, Crum CP, et al. Cervical squamous cell carcinoma in situ with intraepithelial extension to the upper genital tract and invasion of tubes and ovaries: report of a case with human papilloma virus analysis[J]. Int J Gynecol Pathol, 1997, 16(3):272-278. doi: 10.1097/00004347-199707000-00014. doi: 10.1097/00004347-199707000-00014 pmid: 9421094
[16]	Teixeira M, de Magalhães FT, Pardal-de-Oliveira F. Squamous-cell carcinoma of the endometrium and cervix[J]. Int J Gynaecol Obstet, 1991, 35(2):169-173. doi: 10.1016/0020-7292(91)90822-m. doi: 10.1016/0020-7292(91)90822-m
[17]	张颖, 叶元滋, 徐洪海, 等. 子宫颈鳞状细胞癌伴子宫内膜及双侧输卵管扩散1例并文献复习[J]. 临床与实验病理学杂志, 2020, 36(7):837-839. doi: 10.13315/j.cnki.cjcep.2020.07.021. doi: 10.13315/j.cnki.cjcep.2020.07.021
[18]	赵焕芬, 陈小悦, 康林, 等. 子宫颈鳞状细胞癌通过表面扩散累及子宫内膜1例并文献复习[J]. 临床与实验病理学杂志, 2019, 35(3):331-333. doi: 10.13315/j.cnki.cjcep.2019.03.021. doi: 10.13315/j.cnki.cjcep.2019.03.021
[19]	平静, 周东华, 田杰, 等. 子宫颈鳞状细胞癌浅表性扩散临床病理观察[J]. 诊断病理学杂志, 2019, 26(8):531-532,527. doi: 10.3969/j.issn.1007-8096.2019.08.016. doi: 10.3969/j.issn.1007-8096.2019.08.016
[20]	Sood N, Sinha KS. Superficial spreading squamous cell carcinoma endometrium andicthyosis uteri with CINIII with p16 expression: Report of 2 unusual cases[J]. J Krishna Ins Med Sci Univ, 2017, 6(4):126-131.
[21]	Gungor T, Altinkaya SO, Ozat M, et al. Unusual form of superficial spreading squamous cell carcinoma of cervix involving the endometrium, bilateral tubes and ovaries: a case report with literature review[J]. Arch Gynecol Obstet, 2011, 283(2):323-327. doi: 10.1007/s00404-010-1672-1. doi: 10.1007/s00404-010-1672-1 pmid: 20852876
[22]	Punnonen R, Grönroos M, Vaajalahti P. Squamous cell carcinoma in situ from the uterine cervix to the distal end of the fallopian tube[J]. Acta Obstet Gynecol Scand, 1979, 58(1):101-104. doi: 10.3109/00016347909154924. doi: 10.3109/00016347909154924
[23]	Kanbour AI, Stock RJ. Squamous cell carcinoma in situ of the endometrium and fallopian tube as superficial extension of invasive cervical carcinoma[J]. Cancer, 1978, 42(2):570-580. doi: 10.1002/1097-0142(197808)42:2<570::aid-cncr2820420225>3.0.co;2-n. doi: 10.1002/1097-0142(197808)42:2<570::aid-cncr2820420225>3.0.co;2-n pmid: 354770
[24]	Kamalian N, Ghafoorzadeh D. Squamous cell carcinoma of the cervix, with extension in an in situ fashion into the endometrium[J]. Int J Gynaecol Obstet, 1977, 15(3):267-269. doi: 10.1002/j.1879-3479.1977.tb00690.x. doi: 10.1002/j.1879-3479.1977.tb00690.x
[25]	Yang SW, Kim WY, Cho SH, et al. Multifocal microinvasive squamous cell carcinoma with extensive spread of squamous cell carcinoma in situ (CIS) into the uterine corpus, vagina, and left salpinx diagnosed five years after conization of cervical CIS[J]. Eur J Gynaecol Oncol, 2014, 35(5):600-603. pmid: 25423715
[26]	Tan GC, Isa MR, Ng SP, et al. Unusual form of superficial spreading microinvasive squamous cell carcinoma of uterine cervix involving the endometrium of uterus[J]. J Obstet Gynaecol Res, 2004, 30(5):363-367. doi: 10.1111/j.1447-0756.2004.00210.x. doi: 10.1111/j.1447-0756.2004.00210.x
[27]	Martín-Vallejo J, Laforga JB, Molina-Bellido P, et al. Superficial spreading cervical squamous cell carcinoma in situ involving the endometrium: a case report and review of the literature[J]. J Med Case Rep, 2022, 16(1):196. doi: 10.1186/s13256-022-03433-4. doi: 10.1186/s13256-022-03433-4
[28]	Kay S. Squamous-cell carcinoma of the endometrium[J]. Am J Clin Pathol, 1974, 61(2):264-269. doi: 10.1093/ajcp/61.2.264. doi: 10.1093/ajcp/61.2.264 pmid: 4811742
[29]	Wang Z, Dong J, Eyzaguirre EJ, et al. Detection of human papilloma virus subtypes 16 and P16(ink4a) in invasive squamous cell carcinoma of the fallopian tube and concomitant squamous cell carcinoma in situ of the cervix[J]. J Obstet Gynaecol Res, 2009, 35(2):385-389. doi: 10.1111/j.1447-0756.2008.00878.x. doi: 10.1111/j.1447-0756.2008.00878.x