次病人为化疗一个疗程，宫颈肿物质地较硬，累及内膜部分肿物质中，镜下大部分结构为浸润性鳞癌。补充宫颈部HE.及肌上皮及上皮标记。

 Invasive adenosquamous carcinoma, with areas mimicking adenoid cystic carcinoma and basaloid carcinoma, focal cartileginous differentiation also appreciated.

Frankly, i havn't seen such a complex invasive cervical cancer. P16 is positive, consistent with high risk HPV infection as etiology.

 P63在两批图片中显示弥漫阳性。应该还是鳞癌。

至于为什么会在局部或灶性表达CK8和calponin，只能从两方面解释。一方面可能本身就是基底样鳞癌，基底样癌细胞化疗后残留并增殖的干细胞样特征的基底细胞，可能会表达多潜能细胞标志物、另一方面，可能是由于化疗药物毒性杀伤作用，将一定程度“分化”的鳞癌细胞杀死，而残留下来的是具有耐药机制的癌干细胞（在鳞癌，基底样干细胞）样癌细胞增殖，也可能是未知的机制，经化疗药物作用后，残留的癌细胞改变了普通类型的鳞癌的分化方向，向鳞状上皮的干/祖细胞——基底样细胞去分化，成为基底样表型的鳞癌。

P16强阳性提示高危HPV致癌机制，提示高危HPV基因与宿主宫颈上皮（鳞与腺）基因组整合，是宫颈癌及其前驱病变的重要标志物，还说明这个癌在多数情况下是在宫颈发生的。

以上难免谬论，仅供参考。

 好病例，赞同12楼海上明月老师的看法。

P16在HPV感染中出现表达，刚在青岛会上听杨斌博士讲，HPV感染可同时发生鳞和腺的不典型性增生或癌，此例有HPV感染，又有化疗的刺激，会不会是先发生的鳞癌，后继发腺癌，仅仅猜测，期待听专家点评。

 Thank Dr.  dujun0522 for sharing the interesting case and beautiful photos. Notice excellent comment above.

My thought:

1. Invasive cervical cancer

2. Photos show mainly squamous component with focal keratinization and focally glandular component.

3. Morphologic features are not like classic ACC except for one small tumor nest, not like classic basaloid squamous cell ca

4. Stroma change may be caused by treatment.

5. Make things simple and common things are more common. Also clinical treatment will not have much difference. So I would like to call adenosquamous cell carcinoma.

6. All cervical squamous cell ca, adenosquamous cell ca, and most cervical adenocarcinoma ca are HPV related.

7. Clinically sometimes more stains can cause more trouble becasue the result can be difficult to explain.

for your reference