Abstract：
Adenocarcinomas with clear cell morphology may be associated with elevated serum alpha-fetoprotein levels in various organs. We report the case of an alpha-fetoprotein-producing cervical adenocarcinoma with clear cell morphology and compare it immunohistochemically, molecularly, and virologically with cervical clear cell carcinoma, gastric-type mucinous carcinoma, and ovarian clear cell carcinoma. A 51-year-old Japanese woman was initially diagnosed with cervical clear cell carcinoma. The tumor was resistant to standard surgery, radiotherapy, and chemotherapy. Serum carcinoembryonic antigen and alpha-fetoprotein were elevated. The tumor was immunohistochemically positive for alpha-fetoprotein, human chorionic gonadotropin, cytokeratin 20, spalt-like transcription factor 4, glypican 3, MUC6, and HIK1083. Gene panel testing revealed CCNE1 amplification, CDKN2A loss, and TP53 R282W. We compared the present case with 120 ovarian clear cell carcinoma cases using a tissue microarray. Only one case (0.8%) showed very limited immunohistochemical positivity for alpha-fetoprotein. Of the 54 cases in which serum carcinoembryonic antigen was measured, only one (1.9%) was elevated (19.9 ng/mL). We diagnosed the case as alpha-fetoprotein-producing cervical gastric-type mucinous carcinoma with enteroblastic differentiation. In conclusion, alpha-fetoprotein-producing cervical adenocarcinoma is a rare but aggressive tumor. Clinicians and pathologists should be aware of this unfamiliar tumor, its diagnostic clues, prognostic markers, and treatment strategies.
摘要：
具有透明细胞形态的腺癌可能与各种器官中血清甲胎蛋白水平升高有关。我们报告了产生甲胎蛋白的宫颈腺癌，具有透明细胞形态，并进行了免疫组织化学比较，分子，和病毒学上与宫颈透明细胞癌，胃型黏液癌,和卵巢透明细胞癌。一名51岁的日本妇女最初被诊断患有宫颈透明细胞癌。肿瘤对标准手术有抵抗力,放射治疗,和化疗。血清癌胚抗原和甲胎蛋白升高。肿瘤的甲胎蛋白免疫组织化学阳性，人绒毛膜促性腺激素，细胞角蛋白20，类针状转录因子4，磷脂酰肌醇蛋白聚糖3，MUC6和HIK1083。基因组检测显示CCNE1扩增,CDKN2A损失，和TP53R282W。我们使用组织微阵列将本案与120例卵巢透明细胞癌进行了比较。只有1例（0.8％）显示甲胎蛋白的免疫组织化学阳性非常有限。在测量血清癌胚抗原的54例中，只有1例(1.9%)升高(19.9ng/mL).我们将该病例诊断为产生甲胎蛋白的宫颈胃型黏液癌，并伴有肠母细胞分化。总之,产甲胎蛋白的宫颈腺癌是一种罕见但侵袭性的肿瘤。临床医生和病理学家应该意识到这种陌生的肿瘤，它的诊断线索，预后标志物，和治疗策略。
