阴道黏液表皮样癌一例(1)
【摘要】原发于阴道的阴道黏液表皮样癌十分罕见。该文报道一例原发于阴道的黏液表皮样癌患者诊治经过。该例患者以发现阴道肿块4个月，进行性增大1个月为主诉，入院完善检查后予阴道肿瘤切除术。术后病理检查示其肿瘤组织主要由表皮样细胞、黏液细胞及中间型细胞构成，免疫组织化学染色示低分子量细胞角蛋白、高分子量细胞角蛋白等阳性表达，细胞增殖指数Ki67约20%阳性，阿尔新蓝过碘酸雪夫染色阳性。术后2周患者至外院进一步行近距离放射治疗及6个周期的辅助性化学治疗。随访显示患者恢复良好，无复发。原发性阴道黏液表皮样癌的预后与病理分型、临床分期及受累部位相关，除少数早期患者可手术切除外，多以放射治疗为主，辅以化学治疗。
【关键词】阴道；黏液表皮样癌
Mucous epidermoid carcinoma of the vagina： report of one caseLyu Hui Department of Pathology， Wuxi NO2 Peoples Hospital， Wuxi 214002， China
【Abstract】Primary vaginal mucous epidermoid carcinoma (MEC) is extremely rare Herein， we reported the diagnosis and treatment of one case of primary vaginal MEC She had the chief complaints of vaginal masses for four months which were progressively enlarged for one month After complete examinations， she underwent the resection of vaginal tumors Postoperative pathological examination demonstrated that the malignant tumor tissues mainly consisted of epidermallike cells， mucous cells and intermediate cells Immunohistochemical staining revealed the positive expression of low and highmolecular weight cytokeratin Approximately 20% of the Ki67 was positive The ABPAS staining yielded positive outcomes At postoperative two weeks， she was transferred to another hospital and received brachytherapy and six cycles of auxiliary chemotherapy Subsequent followup revealed the patient was well recovered without recurrence The clinical prognosis of primary MEC is correlated with the pathological classification， clinical staging and involved sites Surgical resection is recommended for a few patients with early primary MEC Radiotherapy remains the primary approach， supplemented with chemotherapy
【Key words】Vaginal； Mucous epidermoid carcinoma
黏液表皮樣癌(MEC)是一种常见于腮腺的恶性肿瘤，也可发生于小唾液腺及支气管。原发于阴道的MEC十分罕见，国内外报道很少[1]。现结合一例阴道原发MEC的临床特征与病理特点，复习相关文献，探讨该肿瘤的治疗与预后，以提高临床医师对此类肿瘤的认识水平。
病例资料
一、病史及体格检查
患者女，49岁，因发现阴道肿块4个月，进行性增大1个月于2017年4月2日收入院。4个月前患者体检时发现阴道肿块，未有重视，起病以来偶有外阴疼痛不适，无明显外阴瘙痒，自觉肿块近1个月进行性增大，近半个月无明显诱因出现阴道排液，稀薄蛋清样，有腥臭味。为求进一步诊治，遂来我院就诊。患者孕2产1，23岁首产。平素月经尚规律，月经周期25～30 d，持续3～5 d，量中等。末次月经2017年3月20日，持续5 d，量中等。既往体健，无手术史。
二、体格检查
体温365 ℃，脉搏70 次/分，呼吸17 次/分，血压120/80 mm Hg(1 mm Hg=0133 kPa)。胸部、腹部及脊柱等查体无明显异常。妇科检查：外阴已婚已产型，于阴道后壁近处女膜缘处可触及一40 cm×30 cm×25 cm大小肿块，表面光滑，质地中等，边界清，蒂部略粗，无明显压痛。宫颈轻度炎症，口闭，无接触性出血，无举摆痛。子宫体中位，正常大小，无压痛，活动性好。双侧附件无触及明显肿块。
三、实验室及辅助检查
血常规示血红蛋白144 g/L，白细胞65×109/L，红细胞46×1012/L。癌胚抗原、糖类抗原125、糖类抗原199、糖类抗原153及甲胎蛋白等肿瘤标志物均正常。妇科B超示右侧附件囊性结构，大小约34 mm×29 mm，透声差。, 百拇医药(吕慧)
【关键词】阴道；黏液表皮样癌
Mucous epidermoid carcinoma of the vagina： report of one caseLyu Hui Department of Pathology， Wuxi NO2 Peoples Hospital， Wuxi 214002， China
【Abstract】Primary vaginal mucous epidermoid carcinoma (MEC) is extremely rare Herein， we reported the diagnosis and treatment of one case of primary vaginal MEC She had the chief complaints of vaginal masses for four months which were progressively enlarged for one month After complete examinations， she underwent the resection of vaginal tumors Postoperative pathological examination demonstrated that the malignant tumor tissues mainly consisted of epidermallike cells， mucous cells and intermediate cells Immunohistochemical staining revealed the positive expression of low and highmolecular weight cytokeratin Approximately 20% of the Ki67 was positive The ABPAS staining yielded positive outcomes At postoperative two weeks， she was transferred to another hospital and received brachytherapy and six cycles of auxiliary chemotherapy Subsequent followup revealed the patient was well recovered without recurrence The clinical prognosis of primary MEC is correlated with the pathological classification， clinical staging and involved sites Surgical resection is recommended for a few patients with early primary MEC Radiotherapy remains the primary approach， supplemented with chemotherapy
【Key words】Vaginal； Mucous epidermoid carcinoma
黏液表皮樣癌(MEC)是一种常见于腮腺的恶性肿瘤，也可发生于小唾液腺及支气管。原发于阴道的MEC十分罕见，国内外报道很少[1]。现结合一例阴道原发MEC的临床特征与病理特点，复习相关文献，探讨该肿瘤的治疗与预后，以提高临床医师对此类肿瘤的认识水平。
病例资料
一、病史及体格检查
患者女，49岁，因发现阴道肿块4个月，进行性增大1个月于2017年4月2日收入院。4个月前患者体检时发现阴道肿块，未有重视，起病以来偶有外阴疼痛不适，无明显外阴瘙痒，自觉肿块近1个月进行性增大，近半个月无明显诱因出现阴道排液，稀薄蛋清样，有腥臭味。为求进一步诊治，遂来我院就诊。患者孕2产1，23岁首产。平素月经尚规律，月经周期25～30 d，持续3～5 d，量中等。末次月经2017年3月20日，持续5 d，量中等。既往体健，无手术史。
二、体格检查
体温365 ℃，脉搏70 次/分，呼吸17 次/分，血压120/80 mm Hg(1 mm Hg=0133 kPa)。胸部、腹部及脊柱等查体无明显异常。妇科检查：外阴已婚已产型，于阴道后壁近处女膜缘处可触及一40 cm×30 cm×25 cm大小肿块，表面光滑，质地中等，边界清，蒂部略粗，无明显压痛。宫颈轻度炎症，口闭，无接触性出血，无举摆痛。子宫体中位，正常大小，无压痛，活动性好。双侧附件无触及明显肿块。
三、实验室及辅助检查
血常规示血红蛋白144 g/L，白细胞65×109/L，红细胞46×1012/L。癌胚抗原、糖类抗原125、糖类抗原199、糖类抗原153及甲胎蛋白等肿瘤标志物均正常。妇科B超示右侧附件囊性结构，大小约34 mm×29 mm，透声差。, 百拇医药(吕慧)