Uterine adenocarcinoma with differentiation of germ cell tumors : A clinicopathological study

MA Ya-qi; MENG Gang; LIU Ai-jun; WANG Li-qun; WANG Yun

doi:10.3969/j.issn.1007-8096.2018.05.002

Abstract：Objective To investigate the clinicopathological features,treatment and prognosis of uterine adenocarcinoma with differentiation of germ cell tumors.Methods Two cases of uterine adenocarcinoma with differentiation of germ cell tumors were collected,one high grade endometrial carcinoma with yolk sac tumor differentiation and another cervical adenocarcinoma recurrence after yolk sac tumor with little chorioepithelioma differentiation.The detailed clinical data of two patients were reviewed,and the characteristics of histology and immunohistochemistry were observed,then the related literature was reviewed and summarized.Results Adenocarcinoma with germ cell tumor differentiation was mainly manifested in the clear region of adenocarcinoma and the differentiation area of germ cell tumor.In the adenocarcinoma area,tumor cells showed typical adenoid or stripe like growth;Immunohistochemical staining showed the positive CK,CK7,EMA and PAX8 in tumor cells.In the differentiation area of germ cell tumor (yolk sac tumor or choriocarcinoma differentiation),The tumor cells were microcystic,pseudo adenoid,and solid nested growth.The cells were markedly dysplastic.S-D bodies were seen in some areas.Besides,hemorrhage and necrosis were seen around the tumor cells.Immunohistochemical staining showed that the tumor cells were positive for germ cell tumor markers,such as AFP,SALL4,hCG,PLAP and OCT-4.This kind of disease mainly occured in postmenopausal women with abnormal vaginal bleeding and often accompanied by a rise in blood hCG and/or AFP levels.Conclusion Uterine adenocarcinoma associated with germ cell tumor differentiation may belong to a kind of dedifferentiation,and often missed diagnosis and misdiagnosis in pathological diagnosis.The disease has a strong invasion and poor prognosis.Surgical resection is often used in clinical practice.It is insensitive to radiotherapy and chemotherapy.The patient often dies within 2 years after the operation.