术后意外发现宫颈高分化胃型腺癌个案研究

A case study on incidental postoperative discovery of well-differentiated gastric-type adenocarcinoma of the cervix

  • 摘要: 胃型腺癌(G-EAC)是宫颈腺癌中一种罕见且高度侵袭性的组织学亚型,常因临床表现隐匿、细胞学筛查敏感性低而被漏诊。本文报道1例48岁女性患者,因“月经紊乱伴痛经1年余”接受全子宫及双侧附件切除术,术后病理检查意外确诊为高分化G-EAC。组织学显示,肿瘤细胞胞浆呈广泛透明至泡沫状或淡嗜酸性,腺体结构轻度紊乱,浸润宫颈深部间质。免疫组化特征符合G-EAC典型免疫表型。术后随访至今无疾病进展。高分化G-EAC可缺乏典型症状,常规宫颈癌筛查(如液基薄层细胞学检查/人乳头瘤病毒检测)常呈阴性,极易误诊或漏诊。识别高分化形态学特征及特异性免疫标志物(如Claudin18.2阳性),结合细致的病理评估,对早期诊断与个体化管理至关重要。

     

    Abstract: Gastric-type adenocarcinoma (G-EAC) is a rare and highly aggressive histological subtype of cervical adenocarcinoma, often missed due to its concealed clinical manifestations and low sensitivity of cytological screening. This paper reported a 48-year-old female patient who underwent total hysterectomy and bilateral adnexectomy for "menstrual disorders accompanied by dysmenorrhea for more than one year". Postoperative pathological examination incidentally confirmed well-differentiated G-EAC. Histologically, the tumor cells cytoplasm exhibited extensive clear to foamy or pale eosinophilic, with mildly disordered glandular architecture and infiltration into the deep cervical stroma. Immunohistochemical features were consistent with the typical immunophenotype of G-EAC. There has been no disease progression during postoperative follow-up to date. Well-differentiated G-EAC may lack typical symptoms, and routine cervical cancer screeningsuch as thinprep cytologic test/human papillomavirus testing often yields negative results, making it highly susceptible to misdiagnosis or missed diagnosis. The identification of well-differentiated morphological features and specific immune markers (such as Claudin18.2 positivity), combined with meticulous pathological evaluation, is crucial for early diagnosis and individualized management.

     

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