腟内に向かって乳頭状発育を呈した粘液産生を伴うHPV関連子宮頸部腺癌の1例

A case of HPV associated cervical adenocarcinoma with papillary growth and mucin production

2022年12月刊行の『子宮頸癌取扱い規約 病理編 第5版』において頸癌の組織分類がHPVの関連の有無によって再編成された。HPV関連粘液性癌の画像所見に関するまとまった報告はない。今回我々は，腟内に外向性に発育する特徴的な画像所見を呈した症例を経験したので報告する。

The 5th edition of the General Rules for Clinical and Pathological Studies on Uterine Cervical Cancer（2022）reorganized the histological classification of cervical adenocarcinoma based on human papillomavirus（HPV）status. We report a case of HPV-associated mucinous adenocarcinoma exhibiting prominent exophytic papillary growth into the vagina. A woman in her 40s presented with mucoid discharge and a palpable vaginal mass. MRI revealed a 55mm papillary tumor arising from the anterior cervical portio, with T2-weighted hyperintensity suggesting mucin production. Based on a preoperative clinical diagnosis of FIGO StageⅠB3, radical hysterectomy and bilateral salpingo-oophorectomy were performed. Histopathological examination confirmed HPV-associated mucinous adenocarcinoma characterized by micropapillary and solid growth patterns, signet-ring cell-like morphology, and stratified mucin-producing intraepithelial lesions（SMILE）. Although radiological reports of this subtype are limited, our findings suggest that HPV-associated mucinous adenocarcinoma can present with a papillary architecture mimicking villoglandular adenocarcinoma.