Mutter G L
Department of Pathology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, USA.
J Clin Pathol. 2002 May;55(5):326-31. doi: 10.1136/jcp.55.5.326.
Modern molecular methods for precancer diagnosis have expanded the range of detectable disease to a preclinical level and provided material for histopathological correlation. The precancer scenario begins with sporadic acquisition of rare PTEN mutation bearing glands, which are morphologically unremarkable, and progresses to discrete foci of cytologically altered glands, readily visible on routinely stained sections. Clinical outcome studies of women with endometrial lesions have established threshold diagnostic features that confer increased cancer risk. This class of high risk lesions has been designated endometrial intraepithelial neoplasia (EIN). EIN is diagnosed by presence of cytological demarcation, crowded gland architecture, minimum size of 1mm, and careful exclusion of mimics. Most EIN lesions have been diagnosed as atypical endometrial hyperplasias in the World Health Organisation system. Specialised molecular and morphometric analyses have been extremely useful in redefining clinically relevant premalignant endometrial disease, but translation to improved patient care requires the informed participation of pathologists.
现代用于癌前诊断的分子方法已将可检测疾病的范围扩展到临床前水平，并为组织病理学相关性提供了材料。癌前病变始于散发性获得罕见的携带PTEN突变的腺体，这些腺体在形态上无明显异常，然后发展为细胞学改变的腺体的离散病灶，在常规染色切片上很容易看到。对患有子宫内膜病变的女性进行的临床结局研究确定了具有增加癌症风险的阈值诊断特征。这类高风险病变被命名为子宫内膜上皮内瘤变（EIN）。EIN通过细胞学分界、腺体结构拥挤、最小尺寸为1mm以及仔细排除类似病变来诊断。在世界卫生组织系统中，大多数EIN病变被诊断为非典型子宫内膜增生。专门的分子和形态计量分析在重新定义临床上相关的子宫内膜癌前疾病方面极其有用，但要转化为改善患者护理则需要病理学家的明智参与。
