初期浸潤扁平上皮癌を合併した子宮頸部Clear Cell Adenocarcinomaの1例

抄録

One case of clear cell adenocarcinoma of the uterine cervix is reported in this paper. Detailed analysis of cytologic specimens was performed, and we found somedifferent cytologic features from that of endocervical adenocarcinoma. Case Report.
A forty-eight-year old woman, G. 7P.2, with complaints of vaginal bleeding and low abdominal tenderness, visited our clinic in 1974. This patient's case was diagnosed as myomata uteri and cervical erosion. Leukoplakia, punctation, and mosaic were found on colposcopic examination. Two different types of atypical cells were observed on cytologic examination, one suggesting adenocarcinoma and the other, carcinoma in situ of the uterine cervix. Histologic examination (punch biopsy, cone biopsy, and D & C) revealed early invasive squamous cell carcinoma, mesonephric adenocarcinoma of the uterine cervix, and clear cell adenocarcinoma of the endometrium. Radical hysterectomy, followed by chemotherapy and postoperative radiation, was performed, and the patient was followed up in the out-patient clinic. But she died of pulmonary metastasis and cancerous peritonitis 16 months after the operation.
Histologic Findings
The uterine corpus, child head sized, was elastic and hard. On the cross-section were found microcystic lesions, including bloody mucinous materials in the myometrium and cervical stroma. Bilateral ovaries were normal in appearance. Microscopically, early invasive squamous cell carcinoma was found in the uterine cervix, and tubular adenocarcinoma, suggesting hobnail pattern in some part, was also found in the deep cervical stroma which was situated at 10-12 o'clock and 2-7 o'clock positions of the cervix. Solid clear cell adenocarcinoma was also found in the myometrium penetrating in to the endometrium. These two types of adenocarcinoma had transitional parts in the upper cervical area. Right internal iliac, external iliac, and It parametral lymphnodes were involved by the solid clear cell adenocarcinoma. Staining reaction of these adenocarcinoma was weakly positive with P.A.S. and mucicarmin, but negative with.Sudan-III. Mitosis was rarely found. We thought that these tumors were mesonephric adenocarcinomas arising from the uterine cervix, involving the corpus and lymphnodes, and coexisting with early invasive squamous cell carcinoma of the uterine cervix.
Cytologic Features
Cervical swab smears and touch smears of the hysterectomized specimen were analysed. In the cervical swab smear, many glandular atypical cells were detected, arranged in sheet or isolated (70%). Tumor diathesis was seen. These cells had more abundant cytoplasm, finerchromatin pattern, and more macronucleoli than endocervical adenocarcinoma cells. In the touch smears, tumor diathesis was not seen, and polygonal cytoplasm and irregular chromatin pattern were predominant.
Discussion
Many mesonephric adenocarcinomas of the ovaries have been reported since the first description of Schiller's mesonephroma. Mesonephric remnant or cyst in several parts of the female genital tract were often found; therefore, the extraovarian mesonephric adenocarcinoma may be expected to be more often found. But mesonephric adenocarcinoma of the uterine cervix was rarely reported. Schiller pointed out the glomerulus-like structure as diagnostic criterion of mesonephroma. But Saphir, not agreeing to it, suggested clear cell patterns of the tumor as diagnostic criteria. Many authors used the term of clear cell adenocarcinoma and that of mesonephric adenocarcinoma synonymously. But some of adenocarcinomas and squamous cell carcinomas suggested the clear cell pattern; therefore, only the clear cell adenocarcinoma, suggesting hobnail pattern, peg-like pattern or glomerulus-like structure, should be diagnosed as mesonephric adenocarcinoma.