异时性甲状腺癌合并宫颈鳞状细胞癌和子宫内膜样腺癌1例

Metachronous Thyroid Carcinoma with Synchronous Cervical Squamous Cell Carcinoma and Endometrioid Endometrial Adenocarcinoma: A Case Report

摘要: 背景：临床上，同期原发性妇科肿瘤较为罕见。尤其是宫颈鳞状细胞癌合并子宫内膜样腺癌，在临床上极为少见。鉴于卵巢和子宫内膜联合发病最为常见，多数临床医生会优先考虑这一组合。与此同时，宫颈与子宫内膜同时发生肿瘤的文献报道依然凤毛麟角。因此，必须仔细鉴别这两种独立的原发病变，因为这直接决定了临床治疗方案的选择。病例介绍：患者，44岁绝经后女性，因“异常阴道流血及同房后点滴出血”就诊。宫颈活检证实为浸润性鳞状细胞癌。患者近期曾因甲状腺乳头状癌行左侧甲状腺腺叶及峡部切除术。结合病史，该病例整体表现为异时性甲状腺恶性肿瘤合并同期妇科原发肿瘤。鉴于宫颈肿瘤体积较大，原计划行新辅助化疗。然而，在注射紫杉醇期间发生急性过敏反应，遂立即停药。随后仅使用卡铂完成了该周期化疗。在化疗之后，患者行经腹广泛性子宫切除术 + 双侧附件切除术 + 盆腔淋巴结清扫术 + 膀胱镜下双侧输尿管支架植入术及右侧输尿管膀胱再植术。术后病理示：宫颈鳞状细胞癌(II级)，伴深肌层浸润及脉管浸润；阴道切缘及盆腔淋巴结阴性。此外，意外发现子宫内膜局灶性IA1期子宫内膜样腺癌，源于不典型腺体增生。结论：该病例呈现独特的临床挑战：患者在既往甲状腺恶性肿瘤病史的基础上，发生了罕见的同期妇科双原发恶性肿瘤。子宫内膜癌病灶系术后病理评估中偶然发现；而宫颈癌病灶伴有的深肌层浸润及脉管侵犯，则是决定患者术后辅助治疗方案的关键核心依据。

Abstract: Background: Synchronous primary gynecologic malignancies are rare in clinical practice, and the co-occurrence of cervical squamous cell carcinoma and endometrioid endometrial adenocarcinoma is particularly uncommon. Because combined ovarian and endometrial malignancies are the most frequently reported combination, most clinicians tend to consider this pairing first. Meanwhile, reports of simultaneous cervical and endometrial tumors remain exceedingly scarce in the literature. It is therefore essential to carefully distinguish these two independent primary lesions, as this distinction directly determines the choice of clinical treatment. Case Presentation: A 44-year-old postmenopausal woman presented with “abnormal vaginal bleeding and postcoital spotting”. Cervical biopsy confirmed invasive squamous cell carcinoma. She had recently undergone left thyroid lobectomy with isthmusectomy for papillary thyroid carcinoma. Taken together, this case represented a metachronous thyroid malignancy combined with a synchronous primary gynecologic tumor. Given the large size of the cervical tumor, neoadjuvant chemotherapy was initially planned; however, an acute hypersensitivity reaction occurred during paclitaxel infusion, prompting immediate discontinuation of the drug, and the cycle was completed with carboplatin alone. Following chemotherapy, the patient underwent abdominal radical hysterectomy with bilateral salpingo-oophorectomy, pelvic lymphadenectomy, cystoscopic bilateral ureteral stenting, and right ureteral reimplantation. Postoperative pathology revealed cervical squamous cell carcinoma (grade II) with deep myometrial invasion and lymphovascular space invasion; the vaginal margin and pelvic lymph nodes were negative. In addition, a focal FIGO stage IA1 endometrioid endometrial adenocarcinoma arising from atypical endometrial hyperplasia was incidentally identified. Conclusion: This case presents a unique clinical challenge: a patient with a prior history of thyroid malignancy who developed a rare synchronous double primary gynecologic malignancy. The endometrial carcinoma was an incidental finding on postoperative pathological evaluation, whereas the cervical carcinoma—with its deep myometrial invasion and lymphovascular space invasion—was the key determinant guiding postoperative adjuvant therapy.