罕见非HPV相关宫颈中肾管腺癌误诊一例

doi:10.12280/gjfckx.20250200

摘要/Abstract

摘要：

报告1例罕见的非人乳头瘤病毒（human papilloma virus，HPV）相关宫颈中肾管腺癌（mesonephric adenocarcinoma，MNA）病例，深入分析其临床诊疗特点、病理特征及误诊原因。患者为绝经后女性，无明显临床症状且既往宫颈HPV及液基薄层细胞学检查结果均为阴性。绝经后2年突发阴道出血，临床查体显示宫颈外观正常，但子宫显著增大，初诊时被误判为子宫内膜癌。术后通过组织病理学检查明确诊断为宫颈恶性肿瘤，并经免疫组织化学分析确诊为MNA。本病例强调了多学科协作在非HPV相关宫颈腺癌诊治中的关键作用，提示临床医生应加强对不典型症状患者的关注，综合运用病史采集、实验室检查、影像学评估及病理学分析等手段，拓宽诊断思维，加强多学科协作机制，从而降低误诊率，推动非HPV相关宫颈腺癌的精准诊疗。

关键词: 乳头状瘤病毒科, 淋巴转移, 误诊, 中肾管腺癌, 宫颈腺癌

Abstract:

A case of a rare non-human papilloma virus (HPV)-related mesonephric adenocarcinoma (MNA) of the cervix is reported, and its clinical diagnosis and treatment characteristics, pathological features, and causes of misdiagnosis are analyzed in depth. The patient was a postmenopausal woman with no obvious clinical symptoms, and the previous cervical HPV and thin-prep cytology test results were both negative. She suddenly had vaginal bleeding 2 years after menopause. Clinical physical examination showed that the cervix looked normal, but the uterus was significantly enlarged. At the initial diagnosis, it was misdiagnosed as endometrial cancer. After the surgery, the diagnosis of cervical malignant tumor was confirmed by histopathological examination, and MNA was diagnosed by immunohistochemical analysis. This case emphasizes the crucial role of multi-disciplinary collaboration in the diagnosis and treatment of non-HPV-related cervical adenocarcinoma. It prompts clinicians to pay more attention to patients with atypical symptoms, comprehensively use means such as medical history collection, laboratory tests, imaging evaluation, and pathological analysis, broaden the diagnostic thinking, and strengthen the multidisciplinary collaboration mechanism, so as to reduce the misdiagnosis rate and promote the precise diagnosis and treatment of non-HPV-related cervical adenocarcinoma.

Key words: Papillomaviridae, Lymphatic metastasis, Diagnostic errors, Mesonephric adenocarcinoma, Cervical adenocarcinoma

冯淑娴, 黄子杰, 杨富成, 刘玲. 罕见非HPV相关宫颈中肾管腺癌误诊一例[J]. 国际妇产科学杂志, 2025, 52(5): 512-516.

FENG Shu-xian, HUANG Zi-jie, YANG Fu-cheng, LIU Ling. A Case of Misdiagnosis of A Rare Non-HPV-Related Mesonephric Adenocarcinoma of the Cervix[J]. Journal of International Obstetrics and Gynecology, 2025, 52(5): 512-516.

图/表 4

图1 盆腔MRI矢状位图像注：子宫体积增大（12.6 cm×11.7 cm×8.7 cm），肌层弥漫性增厚，内膜不均匀增厚，宫颈见不规则团块状异常信号（3.7 cm×3.2 cm×3.1 cm）

图2 术后子宫及双侧卵巢输卵管大体标本注：①宫颈管病灶，②增厚的肌层及病灶，③左侧卵巢输卵管，④右侧卵巢输卵管

图3 术后病理图（HE染色×100）注：肿瘤细胞形成密集管状结构，核大、深染、异型显著，标尺=100 μm

图4 术后免疫组织化学图（EnVision染色）注：A PAX-8表达，肿瘤细胞核弥漫性强阳性，×100，标尺=100 μm；B GATA3表达，肿瘤细胞核强阳性，×100，标尺=100 μm；C CD10表达，部分腔缘阳性，×200，标尺=50 μm

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