[摘 要] 目的：探究浸润性复层产生黏液的复层上皮癌（ISMC）的临床组织及分子病理特征。方法： 回顾性分析2018年1月 至2024年4月间安徽医科大学安庆医学中心/安庆市立医院及皖南医学院第一附属医院/弋矶山医院的病理数据库的11例ISMC 和4例产生黏液的复层上皮内病变（SMILE）的临床病理资料、免疫组化、阿利新蓝（AB）/过碘酸雪夫（PAS）染色、分子学检测及 PD-L1表达情况。结果：ISMC患者多表现为阴道不规则流血。细胞质内含有黏液的细胞呈复层排列，周围呈栅栏状，肿瘤细胞 可呈印戒样或胞质透明。ISMC不仅存在单纯型，也可呈混合型。ISMC具有高侵袭性的生物学特性。CK7、p16，p40和（或）p63 表达呈癌巢周栅栏状阳性或局灶表达。AB/PAS染色阳性。人乳头状病毒（HPV）检测结果：ISMC中HPV16/18阳性（1/4），术前 检测出HPV16/18阳性（4/6）；SMILE组织中HPV阴性。ISMC均表达PD-L1。成功随访8例ISMC患者，时间4~39个月（平均20.50 月），4例SMILE患者，时间1~25个月（平均8.25月），随访患者均存活，1例ISMC术后出现多脏器转移。结论：ISMC具有独特的 形态学特征及免疫表型，表现为高侵袭性和不良预后。所有ISMC均呈PD-L1阳性，提示所有患者均可从PD-L1免疫治疗中 获益。

[Abstract] Objective: To investigate the clinicohistologic and molecular pathological characteristics of invasive stratified mucin producing carcinoma (ISMC). Methods: The clinicopathological data, immunohistochemistry, alcian blue/periodic acid-Schiff (AB/ PAS) staining, molecular detection and PD-L1 expressions of 11 cases of ISMC and 4 cases of stratified mucin-producing intraepithelial lesion (SMILE) in the pathological database of Anqing Medical Center of Anhui Medical University /Anqing Municipal Hospital and the first Affiliated hospital of Wannan Medical School/Yijishan Hostital between January of 2018 and March of 2024 were retrospectively analyzed. Results: ISMC patients often presented with irregular vaginal bleeding. Morphologically, the cells containing mucus in the cytoplasm were arranged in stratified layers, surrounded by a palisade, and the tumor cells might be signet ring-shaped or have clear cytoplasm. ISMC might occur in both pure and mixed forms. ISMC had highly invasive biological characteristics. CK7, p16, p40 and (or) p63 were expressed focally or positively in the form of palisades around the cancer nests. AB-PAS staining was positive. HPV test results: HPV16/18 was positive in ISMC (1/4); HPV16/18 was positive before surgery (4/6); no HPV was detected in SMILE; all ISMC cases expressed PD-L1. Eight ISMC patients were successfully followed up for 4-39 months (average 20.50 months), and four SMILE patients for 1-25 months (average 8.25 months). All followed-up patients survived; however, one ISMC patient developed multi organ metastases post-surgery. Conclusion: ISMC has unique morphological characteristics and immunophenotypes, indicated by high invasiveness and poor prognosis. All ISMC are PD-L1 positive, suggesting that these patients may benefit from PD-L1 immunotherapy.

安庆市2023年度医疗卫生类自筹经费科技计划项目（No. 2023Z1002）