内容紹介
A Case of Poorly Differentiated Adenocarcinoma of the Uterine Cervix Treated with Paclitaxel and Carboplatin after Positive PAX 8 Immunostaining
Summary
PAX 8 is a paired-box gene that plays an important role in the embryogenesis of the thyroid gland, Müllerian ducts, and renal/upper urinary tract. PAX 8 expression is observed in carcinomas from each of these sites. Accordingly, PAX 8 immunostaining has been reported to be useful for the diagnosis of these carcinomas. Here, we report a case in which PAX 8 was useful for the diagnosis of a patient with cervical adenocarcinoma and multiple metastases. A 55-year-old female patient complained of cough and genital bleeding. Examination revealed a uterine cervical mass, masses in both breasts, and enlargement of the lymph nodes and subcutaneous nodules. Histology of the uterine cervical mass biopsy revealed a poorly differentiated adenocarcinoma. Cytology of the aspiration biopsy specimens of the breast masses indicated scirrhous cancer. PAX 8 immunostaining of the uterine cervical mass and breast mass biopsies was positive. We determined that the breast masses were metastases of the cervical adenocarcinoma and decided to treat the patient with chemotherapy consisting of paclitaxel and carboplatin. A partial response was observed. A hysterectomy was performed 5 months after chemotherapy because corpus cancer was newly diagnosed. The cervical adenocarcinoma was undetectable in the surgical specimen. Fifteen months have passed since the completion of chemotherapy and the metastases has been under control.
要旨
PAX8は腎臓,甲状腺,ミュラー管由来の臓器の発生段階で不可欠な遺伝子翻訳因子である。また,それらの臓器に発生する腫瘍にも発現することが知られており,組織診断において,その有用性が期待されている。今回,われわれは重複癌との鑑別にPAX8の免疫染色が有用であった子宮頸部腺癌の1例を経験したので報告する。症例は55歳,女性。咳嗽および不正出血の訴えがあり,CT,MRI,PET-CTで両側乳腺腫瘤,全身リンパ節腫大,多発する皮下結節,子宮頸部腫瘤を認めた。子宮頸部腫瘤の生検で低分化型腺癌と診断された。乳腺腫瘤の穿刺吸引細胞診で硬癌が考えられたため,重複癌もしくは子宮頸部腺癌の転移を診断するために,子宮頸部腫瘤および乳腺腫瘤についてPAX8の免疫染色を行った。両者ともにPAX8陽性であったため,子宮頸部腺癌の転移と診断した。TC療法を行い,partial responseを得た。5か月後に子宮体部腫瘤を認め手術を施行したが,子宮頸部腺癌は消失しており,新たに発生した子宮体部類内膜腺癌と診断された。TC療法終了後15か月経過したが,再発を認めず転移巣も増大なく経過している。
目次
Summary
PAX 8 is a paired-box gene that plays an important role in the embryogenesis of the thyroid gland, Müllerian ducts, and renal/upper urinary tract. PAX 8 expression is observed in carcinomas from each of these sites. Accordingly, PAX 8 immunostaining has been reported to be useful for the diagnosis of these carcinomas. Here, we report a case in which PAX 8 was useful for the diagnosis of a patient with cervical adenocarcinoma and multiple metastases. A 55-year-old female patient complained of cough and genital bleeding. Examination revealed a uterine cervical mass, masses in both breasts, and enlargement of the lymph nodes and subcutaneous nodules. Histology of the uterine cervical mass biopsy revealed a poorly differentiated adenocarcinoma. Cytology of the aspiration biopsy specimens of the breast masses indicated scirrhous cancer. PAX 8 immunostaining of the uterine cervical mass and breast mass biopsies was positive. We determined that the breast masses were metastases of the cervical adenocarcinoma and decided to treat the patient with chemotherapy consisting of paclitaxel and carboplatin. A partial response was observed. A hysterectomy was performed 5 months after chemotherapy because corpus cancer was newly diagnosed. The cervical adenocarcinoma was undetectable in the surgical specimen. Fifteen months have passed since the completion of chemotherapy and the metastases has been under control.
要旨
PAX8は腎臓,甲状腺,ミュラー管由来の臓器の発生段階で不可欠な遺伝子翻訳因子である。また,それらの臓器に発生する腫瘍にも発現することが知られており,組織診断において,その有用性が期待されている。今回,われわれは重複癌との鑑別にPAX8の免疫染色が有用であった子宮頸部腺癌の1例を経験したので報告する。症例は55歳,女性。咳嗽および不正出血の訴えがあり,CT,MRI,PET-CTで両側乳腺腫瘤,全身リンパ節腫大,多発する皮下結節,子宮頸部腫瘤を認めた。子宮頸部腫瘤の生検で低分化型腺癌と診断された。乳腺腫瘤の穿刺吸引細胞診で硬癌が考えられたため,重複癌もしくは子宮頸部腺癌の転移を診断するために,子宮頸部腫瘤および乳腺腫瘤についてPAX8の免疫染色を行った。両者ともにPAX8陽性であったため,子宮頸部腺癌の転移と診断した。TC療法を行い,partial responseを得た。5か月後に子宮体部腫瘤を認め手術を施行したが,子宮頸部腺癌は消失しており,新たに発生した子宮体部類内膜腺癌と診断された。TC療法終了後15か月経過したが,再発を認めず転移巣も増大なく経過している。