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原发性腹膜和卵巢浆液性乳头状腺癌的临床病理

张静 梁智勇 高洁 曾瑄 刘彤华

张静, 梁智勇, 高洁, 曾瑄, 刘彤华. 原发性腹膜和卵巢浆液性乳头状腺癌的临床病理[J]. 协和医学杂志, 2012, 3(1): 77-83. doi: 10.3969/j.issn.1674-9081.2012.01.017
引用本文: 张静, 梁智勇, 高洁, 曾瑄, 刘彤华. 原发性腹膜和卵巢浆液性乳头状腺癌的临床病理[J]. 协和医学杂志, 2012, 3(1): 77-83. doi: 10.3969/j.issn.1674-9081.2012.01.017
Jing ZHANG, Zhi-yong LIANG, Jie GAO, Xuan ZENG, Tong-hua LIU. Clinicopathological Features and Immunohistochemical Comparison of Primary Peritoneal and Primary Ovarian Serous Papillary Carcinoma[J]. Medical Journal of Peking Union Medical College Hospital, 2012, 3(1): 77-83. doi: 10.3969/j.issn.1674-9081.2012.01.017
Citation: Jing ZHANG, Zhi-yong LIANG, Jie GAO, Xuan ZENG, Tong-hua LIU. Clinicopathological Features and Immunohistochemical Comparison of Primary Peritoneal and Primary Ovarian Serous Papillary Carcinoma[J]. Medical Journal of Peking Union Medical College Hospital, 2012, 3(1): 77-83. doi: 10.3969/j.issn.1674-9081.2012.01.017

原发性腹膜和卵巢浆液性乳头状腺癌的临床病理

doi: 10.3969/j.issn.1674-9081.2012.01.017
详细信息
    通讯作者:

    刘彤华 电话:010-65295523, E-mail:liuthp-umch@yahoo.com.cn

  • 中图分类号: R73;R446.8

Clinicopathological Features and Immunohistochemical Comparison of Primary Peritoneal and Primary Ovarian Serous Papillary Carcinoma

More Information
  • 摘要:   目的  分析比较原发于腹膜和卵巢的浆液性乳头状腺癌的临床病理特征及免疫组化特点。  方法  选取北京协和医院手术切除的10例符合原发性腹膜浆液性乳头状腺癌(primary peritoneal serous papillary carcinoma, PPSPC)定义(即病变以腹膜或网膜为主, 双侧卵巢结构正常, 或病变仅累及卵巢表面上皮)及20例与之临床分期配对的原发性卵巢浆液性乳头状腺癌(ovarian serous papillary cancer, OSPC)的病例标本, 分析PPSPC和OSPC临床病理学特点, 用免疫组织化学染色法观察雌激素受体(estrogen receptor, ER)、孕激素受体(progesterone receptor, PR)、人表皮生长因子受体2(human epidermalgrowth factor receptor2, HER2)及P53蛋白的表达; 采用荧光原位杂交(fluorescence in situ hybridization, FISH)检测两组标本的HER2基因状态。  结果  PPSPC患者平均发病年龄较OSPC患者大8.3岁, 两组比较差异具有统计学意义(P=0.045)。PPSPC患者中60%为低分化浆液性癌, 而OSPC患者中仅20%为低分化浆液性癌, 两组比较差异具有统计学意义(P=0.045)。免疫组化结果显示, ER和PR在PPSPC组中的表达(分别为60%和10%)明显低于OSPC组(分别为95%和50%)(P=0.031和P=0.032)。P53蛋白在两组中的表达与ER和PR类似, 40% PPSPC病例P53呈阳性表达, 85% OSPC病例P53呈阳性表达, 两组比较差异具有统计学意义(P=0.045)。PPSPC组中仅1例(10%, 1/10)出现轻度不连续细胞膜着色(即1+), 而OSPC组则有3例(15%, 3/20)出现HER2(1+); PPSPC及OSPC组均无HER2过表达病例。此外, 在PPSPC与OSPC组均未发现HER2基因扩增或基因拷贝数高度增加。  结论  PPSPC与OSPC尽管在组织病理学、临床特点及分子生物学特征上有相似之处, 但前者更常见于老年女性, 肿瘤分化差, 具有较强的侵袭性, ER和/或PR低表达, P53阳性表达也低于后者, 临床结局不良。
  • 图  1  原发性腹膜浆液性乳头状腺癌, 低倍镜下见肿瘤细胞呈小巢状或条索状弥漫浸润脂肪组织; 高倍镜下见瘤细胞核浆比大, 核染色质深, 异型性明显

    图  2  原发卵巢浆液性乳头状腺癌, 低倍镜下见肿瘤呈不规则分支状乳头结构, 表面乳头纤细, 结构复杂; 高倍镜下见瘤细胞排列紧密, 层次增多, 有异型性

    图  3  免疫组化ER染色

    a.原发性腹膜浆液性乳头状腺癌, 肿瘤细胞核呈中等强度阳性表达; b.原发卵巢浆液性乳头状腺癌, 肿瘤细胞核呈强阳性表达

    图  4  免疫组化PR染色

    a.原发性腹膜浆液性乳头状腺癌, 肿瘤细胞核呈中等强度阳性表达; b.原发性卵巢浆液性乳头状腺癌, 肿瘤细胞核呈强阳性表达

    图  5  免疫组化P53染色

    a.原发性腹膜浆液性乳头状腺癌, 肿瘤细胞核呈阳性表达; b.原发性卵巢浆液性乳头状腺癌, 肿瘤细胞核呈阳性表达

    图  6  免疫组化HER2染色

    a.原发性腹膜浆液性乳头状腺癌, 肿瘤细胞膜未着色; b.原发性卵巢浆液性乳头状腺癌免疫组化HER2染色, 1 +, > 10%细胞的细胞膜和细胞浆出现轻度棕黄色, 染色间断, 未包绕胞膜

    表  1  4种抗体实验室来源与实验条件

    表  2  原发性腹膜浆液性乳头状腺癌与卵巢浆液性乳头状腺癌临床病理特点(n)

  • [1] Swerdlow M. Mesothelioma of the pelvic peritoneum resembling papillary cystadenocarcinoma of the ovary:case report[J]. Am J Obstet Gynecol, 1959, 77:197-200. doi:  10.1016/0002-9378(59)90287-X
    [2] Stenchever M, Embryology[M]//Droegemuller W, Herbst AL, Mishell Jr DR, et al. Comprehensive gynecology. St. Louis: CV Mosby, 1988: 8-11.
    [3] Bloss JD, Liao SY, Buller RE, et al. Extraovarian peritoneal serous papillary carcinoma:a case-control retrospective comparison to papillary adenocarcinoma of the ovary[J]. Gynecol Oncol, 1993, 50:347-351. doi:  10.1006/gyno.1993.1223
    [4] Zhang C, Li XP, Cui H, et al. Advanced primary peritoneal carcinoma:clinicopathological and prognostic factor analyses[J]. J Zhejiang Univ Sci B, 2008, 9:435-440. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2408695/
    [5] Killackey MA, Davis AR. Papillary serous carcinoma of the peritoneal surface:matched-case comparison with papillary serous ovarian carcinoma[J]. Gynecol Oncol, 1993, 51:171-174. doi:  10.1006/gyno.1993.1267
    [6] Shen DH, Khoo US, Xue WC, et al. Primary peritoneal malignant mixed mullerian tumors. A clinicopathologic, immunohistochemical and genetic study[J]. Cancer, 2001, 91:1052-1060. doi:  10.1002/1097-0142(20010301)91:5<1052::AID-CNCR1097>3.0.CO;2-A
    [7] Halperin R, Zehavi S, Hadas E, et al. Immunohistochemical comparison of primary peritoneal and primary ovarian serous papillary carcinoma[J]. Int J Gynecol Pathol, 2001, 20:341-345. doi:  10.1097/00004347-200110000-00005
    [8] Schorge JO, Muto MG, Lee SJ, et al. BRCA1-related papillary serous carcinoma of the peritoneum has a unique molecular pathogenesis[J]. Cancer Res, 2000, 60:1361-1364. http://www.ncbi.nlm.nih.gov/pubmed/10728699
    [9] International Federation of Gynecology and Obstetrics. Staging announcement:FIGO Cancer Committee[J]. Gynecol Oncol, 1986, 25:383-385. doi:  10.1016/0090-8258(86)90092-2
    [10] Hammock L, Lewis M, Phillips C, et al. Strong HER-2/neu protein overexpression by immunohistochemistry often does not predict oncogene amplification by fluorescence in situ hybridization[J]. Hum Pathol, 2003, 34:1043-1047. doi:  10.1053/S0046-8177(03)00409-X
    [11] Yaziji H, Gown AM. Accuracy and precision in HER-2/neu testing in breast cancer:are we there yet?[J]. Hum Pathol, 2004, 35:143-146. doi:  10.1016/j.humpath.2004.01.002
    [12] 曾瑄, 赵大春, 周炜洵, 等.荧光原位杂交检测乳腺癌HER2基因状态[J].中华病理学杂志, 2005, 34:701-705. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhblx200511001
    [13] Wolff AC, Hammond ME, Schwartz JN, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer[J]. J Clin Oncol, 2007, 25:118-145. http://www.ncbi.nlm.nih.gov/pubmed/17159189
    [14] Dubeau L. The cell of origin of ovarian epithelial tumours[J]. Lancet Oncol, 2008, 9:1191-1197. doi:  10.1016/S1470-2045(08)70308-5
    [15] Choi CH, Kim TJ, KimWY, et al. Papillary serous carcinoma in ovaries of normal size:a clinicopathologic study of 20 cases and comparison with extraovarian peritoneal papillary serous carcinoma[J]. Gynecol Oncol, 2007, 105:762-768. doi:  10.1016/j.ygyno.2007.02.020
    [16] Pentheroudakis G, Pavlidis N. Serous papillary peritoneal carcinoma:unknown primary tumour, ovarian cancer counterpart or a distinct entity? A systematic review[J]. Crit Rev Oncol Hematol, 2010, 75:27-42. doi:  10.1016/j.critrevonc.2009.10.003
    [17] Bizzi A. Codegoni AM, Landoni F, et al. Steroid receptors in epithelial ovarian carcinoma:relation to clinical parameters and survival[J]. Cancer Res, 1988, 48:6222-6226. http://www.ncbi.nlm.nih.gov/pubmed/3167868
    [18] Kommoss F, Pfisterer J, Thome M, et al. Steroid receptors in ovarian carcinoma:immunohistochemical determination may lead to new aspects[J]. Gynecol Oncol, 1992, 47:317-322. doi:  10.1016/0090-8258(92)90133-4
    [19] Geisler JP, Wiemann MC, Miller GA, et al. Estrogen and progesterone receptor status as prognostic indicators in patients with optimally cytoreduced stage IIIC serous cystadenocarcinoma of the ovary[J]. Gynecol Oncol, 1996, 60:424-427. doi:  10.1006/gyno.1996.0067
    [20] Lee Y, Park N. Prognostic value and clinicopathological significance of p53 and PTEN in epithelial ovarian cancers[J]. Gynecol Oncol, 2009, 112:475-480. doi:  10.1016/j.ygyno.2008.11.031
    [21] Vang R, Shih I, Salani R, et al. Subdividing ovarian and peritoneal serous carcinoma into moderately differentiated and poorly differentiated does not have biologic validity based on molecular genetic and in vitro drug resistance data[J]. Am J Surg Pathol, 2008, 32:1667-1674. doi:  10.1097/PAS.0b013e31816fd555
    [22] Chen LM, Yamada SD, Fu YS, et al. Molecular similarities between primary peritoneal and primary ovarian carcinomas[J]. Int J Gynecol Cancer, 2003, 13:749-755. doi:  10.1136/ijgc-00009577-200311000-00004
    [23] Tuefferd M, Couturier J, Penault-Llorca F, et al. HER2 status in ovarian carcinomas:a multicenter GINECO study of 320 patients[J]. PLoS One, 2007, 2:e1138. doi:  10.1371/journal.pone.0001138
    [24] Steffensen KD, Waldstom M, Andersen RF, et al. Protein levels and gene expressions of the epidermal growth factor receptors HER1, HER2, HER3 and HER4 in benign and malignant epithelial ovarian tumours[J]. Int J Oncol, 2008, 33:195-204. http://www.ncbi.nlm.nih.gov/pubmed/18575766
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  • 收稿日期:  2011-11-03
  • 刊出日期:  2012-01-30

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