Ogawa S, Kaku T, Amada S, Kobayashi H, Hirakawa T, Ariyoshi K, Kamura T, Nakano H
Department of Obstetrics and Gynecology, School of Health Sciences, Second Department of Pathology, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka City, 812-8582, Japan.
Gynecol Oncol. 2000 May;77(2):298-304. doi: 10.1006/gyno.2000.5765.
The purpose of this study was to demonstrate the incidence, the histopathological characteristics, and the proliferation activity of endometriosis and atypical endometriosis associated with ovarian carcinoma.
Microscopic slides of primary lesions from 127 patients with primary ovarian carcinoma were reviewed. The presence or absence of endometriosis and the transitions from typical endometriosis to atypical endometriosis and from atypical endometriosis to carcinoma were also histologically evaluated. Ki-67 immunoreactivity of typical and atypical endometriosis and carcinoma was examined. In addition, endometrial metaplasias were also evaluated.
Of the 127 patients, 37 had endometriosis: 70% (30/43) had clear cell adenocarcinoma, 43% (3/7) had endometrioid adenocarcinoma, 7% (4/60) had serous adenocarcinoma, and none (0/17) had mucinous adenocarcinoma. Thirty-three cases showed typical endometriosis and 29 cases had atypical endometriosis (25 cases had both). Tufting and the stratification of the lining epithelium were observed in 25 and 23 cases, respectively. The transition from typical endometriosis to atypical endometriosis was observed in 22 cases, and the transition from atypical endometriosis to carcinoma, in 23 cases. Only one case showed a direct transition from typical endometriosis to carcinoma. The mean Ki-67 indices were as follows: ovarian carcinoma, 23.1; atypical endometriosis, 9.9; typical endometriosis, 2.7. In 18 cases with metaplasia in endometriosis, eosinophilic metaplasia and ciliated metaplasia were the most common types. Five cases had two types of metaplasia.
Ovarian carcinomas, especially clear cell and endometrioid adenocarcinomas, are highly associated with endometriosis. Atypical endometriosis shows proliferation activity intermediate to those of typical endometriosis and ovarian carcinoma, suggesting it is a precancerous status.
本研究旨在阐明与卵巢癌相关的子宫内膜异位症及非典型子宫内膜异位症的发病率、组织病理学特征及增殖活性。
回顾了127例原发性卵巢癌患者原发灶的显微切片。对子宫内膜异位症的有无以及从典型子宫内膜异位症向非典型子宫内膜异位症、从非典型子宫内膜异位症向癌的转变进行了组织学评估。检测了典型和非典型子宫内膜异位症及癌的Ki-67免疫反应性。此外，还对子宫内膜化生进行了评估。
127例患者中，37例有子宫内膜异位症：70%（30/43）为透明细胞腺癌，43%（3/7）为子宫内膜样腺癌，7%（4/60）为浆液性腺癌，无一例（0/17）为黏液性腺癌。33例显示典型子宫内膜异位症，29例有非典型子宫内膜异位症（25例两者均有）。分别在25例和23例中观察到衬里上皮的簇状和分层。22例观察到从典型子宫内膜异位症向非典型子宫内膜异位症的转变，23例观察到从非典型子宫内膜异位症向癌的转变。仅1例显示从典型子宫内膜异位症直接向癌的转变。平均Ki-67指数如下：卵巢癌为23.1；非典型子宫内膜异位症为9.9；典型子宫内膜异位症为2.7。在18例子宫内膜异位症有化生的病例中，嗜酸性化生和纤毛化生是最常见的类型。5例有两种化生类型。
卵巢癌，尤其是透明细胞癌和子宫内膜样腺癌，与子宫内膜异位症高度相关。非典型子宫内膜异位症的增殖活性介于典型子宫内膜异位症和卵巢癌之间，提示其为癌前状态。
