Tambouret Rosemary, Clement Philip B, Young Robert H
James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
Am J Surg Pathol. 2003 Aug;27(8):1080-8. doi: 10.1097/00000478-200308000-00005.
The prognosis of endometrial endometrioid adenocarcinoma is determined in part by stage; endocervical stromal involvement (stage IIB) imparts a worsened prognosis. We describe a deceptive pattern of stage IIB disease that mimics a primary endocervical glandular proliferation and may lead to understaging of endometrial endometrioid adenocarcinoma. Fifteen cases of endometrial endometrioid adenocarcinoma with a peculiar pattern of cervical involvement were identified from our consultation files. All cases were referred in consultation because of doubt about the nature of the cervical process and its relation to the corpus tumor; in a few instances, the cervical proliferation was considered possibly benign and in one case was misinterpreted as mesonephric hyperplasia. The patients ranged from 49 to 84 years in age (mean age 64.9 years). There was usually a grossly evident endometrial tumor. The cervix was unremarkable grossly in at least 11 patients. The cervical tumors were composed of variably shaped, often tubular glands with little or no stromal response and mainly invaded as widely spaced glands that often appeared deceptively benign. In 14 cases luminal secretions, mainly eosinophilic, were identified, often leading to consideration of a mesonephric lesion. Ten of the endometrial tumors were grade 1, four grade 2, and one grade 3. One was noninvasive, nine superficially invasive, and five deeply invasive. In four cases myoinvasion had, at least in part, a diffusely infiltrative pattern. The tumors in the cervix showed no in situ component and no definite surface involvement. Continuity with the corpus tumor could be demonstrated in 12 cases. Ten of the cervical tumors invaded more deeply than the endometrial tumor, four invaded to a similar depth, and only one was more superficial than its endometrial counterpart. The cervical and corpus tumors had a similar immunoprofile in nine cases: all were vimentin positive, eight estrogen positive and one negative, four carcinoembryonic antigen negative, and five with focal apical or rare cytoplasmic staining. This immunoprofile in conjunction with routine morphologic similarity between the two tumors and the usual documented continuity between them indicate that the cervical process represents spread from the endometrial endometrioid adenocarcinoma. It is important for both therapeutic and prognostic reasons that the cervical abnormality is not misinterpreted as a benign or malignant primary endocervical glandular process.
子宫内膜样腺癌的预后部分取决于分期；宫颈间质受累（IIB期）会使预后变差。我们描述了一种IIB期疾病的欺骗性模式，它类似于原发性宫颈腺体增生，可能导致子宫内膜样腺癌分期过低。从我们的会诊档案中识别出15例具有特殊宫颈受累模式的子宫内膜样腺癌。所有病例均因对宫颈病变的性质及其与子宫体肿瘤的关系存在疑问而被转诊会诊；在少数情况下，宫颈增生被认为可能是良性的，在1例中被误诊为中肾增生。患者年龄在49岁至84岁之间（平均年龄64.9岁）。通常有肉眼可见的子宫内膜肿瘤。至少11例患者的宫颈外观无明显异常。宫颈肿瘤由形状各异、通常为管状的腺体组成，间质反应很少或没有，主要以间隔较宽的腺体形式浸润，这些腺体常常看似良性，具有欺骗性。在14例病例中发现了腔内分泌物，主要为嗜酸性，这常常导致考虑为中肾病变。10例子宫内膜肿瘤为1级，4例为2级，1例为3级。1例为非浸润性，9例为浅表浸润性，5例为深部浸润性。在4例病例中，肌层浸润至少部分呈弥漫性浸润模式。宫颈肿瘤未显示原位成分，也没有明确的表面受累。12例病例中可证明与子宫体肿瘤连续。10例宫颈肿瘤的浸润深度超过子宫内膜肿瘤，4例浸润深度相似，只有1例比其对应的子宫内膜肿瘤更浅表。9例病例中宫颈和子宫体肿瘤具有相似的免疫表型：所有病例波形蛋白均为阳性，8例雌激素为阳性，1例为阴性，4例癌胚抗原为阴性，5例有局灶性顶端或罕见的细胞质染色。这种免疫表型与两种肿瘤之间常规的形态学相似性以及它们之间通常记录的连续性表明，宫颈病变代表子宫内膜样腺癌的扩散。出于治疗和预后的原因，重要的是不要将宫颈异常误解为原发性宫颈腺体的良性或恶性病变。
