Abstract
We investigated the frequency, histopathologic, and immunohistochemical characteristics of tubal involvement in uterine serous carcinoma (USC) and aimed to clarify the relationship between "serous tubal intraepithelial carcinoma (STIC)" and USC in these cases. Cases of USC with complete tubal examination were prospectively collected and reviewed for the presence of tubal involvement. Immunohistochemical analysis for p53 and WT1 was performed on the endometrial and tubal tumor in cases with tubal involvement. Of 161 USC cases (pure USC or a component of a mixed carcinoma or a carcinosarcoma), 32 (20%) showed tubal involvement (unilateral: n=19; bilateral: n=13). The uterine tumors in cases with tubal involvement showed a trend toward increased likelihood of deep myometrial and lymphovascular invasion (LVI) compared with those without tubal involvement. The tubal fimbriae were involved in 15/32 cases. Tubal involvement was mucosal in 30/32 cases, mural in 14/32, serosal in 5/32, invasive in 22/32, and there was LVI in the tube in 13/32. STIC-like features were seen in 17/32 cases (7 as the only pattern of involvement, 9 with associated invasive carcinoma, and 5 with LVI). Immunostaining showed complete concordance of p53 and WT1 between the endometrial and tubal tumors in 26/32 cases, the majority being WT1 negative or only focally positive (19/26), and all exhibiting mutation-type p53 staining. On the basis of the histologic and immunohistochemical features, the tubal tumor was considered to represent metastatic USC in 26/32 cases, most likely metastatic USC in 2/32 cases, an independent tubal primary tumor in 3/32 cases, and to be of uncertain origin in the 1 remaining case. STIC-like lesions were considered to represent metastatic USC in 12/17 cases, most likely metastatic USC in 2/17 cases, an independent tubal primary in 2/17 cases, and of uncertain origin in the 1 remaining case. Tubal involvement, including STIC-like lesions, is seen in one fifth of USC when the tubes are examined in their entirety. The tubal involvement is metastatic in the vast majority of cases. Immunohistochemical studies assist, in most cases, in confirming the metastatic nature of the tubal disease. Consideration should be given to completely examining the fallopian tubes in apparent stage I or II USCs, as this will result in upstaging in a significant minority of cases.
摘要
我们研究了子宫浆液性癌（uterine serous carcinoma, USC）发生输卵管累及的几率，及伴有输卵管累及的USC其组织病理和免疫组化方面的特征，试图通过这些病例说明”浆液性输卵管上皮内癌（serous tubal intraepithelial carcinoma, STIC）”与子宫浆液性癌（USC）之间的关系。
此项前瞻性研究中，我们对USC的病例细致的进行输卵管取材检查，然后检查是否其累及输卵管。这些病例中，利用免疫组化对子宫内膜的肿瘤和输卵管转移性肿瘤（USC累及输卵管）的p53和WT1进行分析。研究的161例USC病例中（包括单纯性USC, 混合型USC和子宫浆液性癌肉瘤），其中有32例（20%）累及输卵管（累及单侧输卵管有19例，累及双侧输卵管有13例）。与那些没有累及输卵管的USC相比较，这些伴有输卵管累及的USC病例其表现出子宫深肌层浸润和淋巴管浸润（lymphovascular invasion, LVI）的趋势。这32例输卵管累及的USC病例中，有15例累及到了输卵管伞部。输卵管粘膜受到累及的有30例（30/32），整个管壁受到累及的有14例（14/32），输卵管浆膜受到累及的有5例（5/32），呈浸润性的有22例（22/32），发生输卵管LVI的有13例（13/32）。我们观察到17例（17/32）具有STIC样的特征（7例表现出仅仅伴有输卵管累及的特征，9例与浸润性的癌相关，5例与淋巴管浸润相关）。这32例中有26例其p53和WT1在子宫内膜的肿瘤和输卵管转移性肿瘤表现出完全一致性，这26例中大多数病例WT1阴性或者仅仅局灶阳性（19/26），这26例全部表现出突变型p53阳性染色。基于组织学和免疫组化特征，我们认为这32例输卵管转移性肿瘤中有26例代表了转移性USC，有2例最可能是转移性USC,有3例代表了独立的输卵管原发性肿瘤，剩下的1例不确定来源。在17例STIC样病变的病例中，有12例代表了转移性USC，有2例最可能是转移性USC，有2例代表了独立的输卵管原发性肿瘤，剩下的1例不确定来源。当我们细致的对整个输卵管进行取材检查后，我们发现有五分之一的USC病例中累及了输卵管，其中包括STIC样的病变。这些累及输卵管的病例中，大多数是转移性质的。免疫组化分析进一步有利于确认输卵管疾病的转移特性。
在明显的I期 或者II期USC病例中，应该完整的细致检查输卵管是否累及，因为这样有可能提高一小部分病例的分期。
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