Primary clear cell adenocarcinoma of the cervix:a clinicopathological analysis of 16 cases

ZHAO Xiao-yan; ZHANG Yao; QIAO Jia-xin; REN Zhi-min; LI Wen-cai; LI Xin-min

doi:10.3969/j.issn.1007-8096.2025.03.008

Abstract：Objective To explore the clinicopathological characteristics,and to help for diagnosis,treatment and prognosis of primary clear cell adenocarcinoma of the cervix(PCCAC).Methods A retrospective analysis was conducted in 16 cases of PCCAC to study their clinical pathology,imaging,laboratory examination,and immune phenotype characteristics.Results The patients aged from 9 to 77 years,with averaged age 49 years.The clinical symptoms were contact bleeding or vaginal abnormal bleeding in 13 cases,with brown vaginal discharge with foul smell in 1 case,lower abdomen pain in 1 case.There were no obvious symptoms in 1 case.10 cases had obvious swelling on the cervix or internal cervical mass,3 cases had cervical erosion,and 3 cases had no obvious lesions.Microscopically,tumour cells grew in papillary,glandular tubes,tubular cystic or solid.Under high magnification,tumor cells were clear cells or flat cells.The nucleus was polymorphic.Nucleolus could be seen,with abundant transparent cytoplasm.The cell edges were clear,some of the cells were shoe-spike-like.The tumor interstitium was fibrous.There were more lymphocytic and plasma cell infiltration.p16(9/10),NapsinA(7/9)in cancer cells were all positive or partially positive.PAX-8(9/9),HNF-1β(12/12),CK7(7/7)in cancer cells were all positive.ER,PR,CD10,CEA of 16 cases were all negative.The proliferative index of Ki-67 was 5%-70%,with average 31.88%.1 case was positive and 15 cases were negative in HPV test.Conclusion PCCAC is a rare malignancy of the cervix.There is no obvious specificity in clinical presentation,and no significant association with HPV infection.Diagnosis of PCCAC is based on histopathological morphology.Attention should be paid to distinguish it from renal carcinoma in the cervix and metastatic carcinoma of the cervix.Immunophenotyping is helpful in the diagnosis and differential diagnosis.