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子宮頸鱗狀細胞原位癌合併陰道鱗狀細胞原位癌之臨床病理學研究－病例報告及文獻回顧
Clinical and Pathologic Study of Cervical Squamous Cell Carcinoma in Situ with Concomitant Vaginal Squamous Cell Carcinoma in Situ: Two Cases Report and Review of Literatures
摘要
子宮頸鱗狀細胞原位癌合併陰道鱗狀細胞原位癌為腫瘤病灶，相當罕見。本文報告兩例病例，分別為39歲和66歲女性患者，患者均因為子宮頸原位癌而接受子宮切除手術峙，偶然發現陰道原位癌，經病理切片證實為子宮頸鱗狀細胞原位癌合併陰道鱗狀細胞原位癌，腫瘤病灶均位於陰道上1／3處，臨床症狀均為陰道出血，肉眼所見陰道均無明顯腫瘤病灶，兩例均先後接受子宮切除、卵巢輸卵管切除、部分陰道切除和手術後放射線治療。治療後迄今分別8個月和4個月的追蹤，兩例存活良好，均無局部復發和遠端轉移。本文藉病例報告及文獻回顧討論子宮頸合併陰道鱗狀細胞原位癌之致病機轉，並且探討陰道原發性鱗狀細胞癌之流行病學、臨床特性、治療方法及預後。
並列摘要
Two patients, who developed rare cervical squamous cell carcinoma, carcinoma in situ with glandular involvement, with concomitant vaginal squamous cell carcinoma, carcinoma in situ, were presented. Two patients were aged 39 years old and 66 years old respectively. The vaginal squamous cell carcinoma, carcinoma in situ, was occasionlly found during the hysterectomy for cervical squamous cell carcinoma, carcinoma in siut with glandular involvement, in these two cases. The vaginal multiple neoplastic lesions were located in upper third region. Two patients all presented vaginal bleeding only. Grossly, no obvious tumor lesion could be identified in resected vaginal cuff tissue. These two patients were treated with radiotherapy following hysterectomy and partial vaginectomy. After treatment, no local recurrence or distant metastasis had been found for eight months and four months follow up respectively. The pathogenesis of cervical squamous cell CIS combined with vaginal sguamous cell CIS and the epidemiology, clinical characteristics, treatment, complication and prognosis of primary vaginal squamous cell carcinoma were discussed. The strikingly high frequent association of vaginal cancers with cervical neoplasms emphasized the multicentric occurence of carcinoma in the female lower genital tract. Because of Multicentric occurence and delayed effect of malignant tumors in female lower genital tract, the importance of lifelong periodic clinical and cytologic examinations of vaginus in all patients, who received hysterectomy, with or without a history of previous cervical neoplasia is stressed for the detection of early vaginal neoplastic lesions.