Elishaev Esther, Gilks C Blake, Miller Dianne, Srodon Monica, Kurman Robert J, Ronnett Brigitte M
Department of Pathology, Johns Hopkins University School of Medicine and Hospital, Baltimore, MD 21231, USA.
Am J Surg Pathol. 2005 Mar;29(3):281-94. doi: 10.1097/01.pas.0000152136.81771.12.
The vast majority of endocervical adenocarcinomas are high-risk human papillomavirus (HPV)-related neoplasms, characterized by p16 expression and frequent loss of hormone receptor expression, which infrequently metastasize to the ovaries. We report 10 cases of endocervical adenocarcinomas with ovarian metastases in which the ovarian tumors simulated primary ovarian surface epithelial neoplasms. The presence of HPV DNA was assessed to determine whether the ovarian neoplasms were metastases or independent neoplasms. Immunohistochemistry for hormone receptors and p16 was also performed. The ovarian metastases presented concurrently with the primary endocervical tumors in 5 cases, subsequent to the endocervical tumors in 3 cases, and prior to diagnosis of the endocervical tumors in 2 cases. The ovarian tumors ranged in size from 2 to 30 cm, with tumors in 7 cases measuring 10 cm or greater. The ovarian tumors were unilateral in 8 cases and bilateral in 2. In all cases, the ovarian tumors were initially diagnosed as or thought to represent independent primary ovarian surface epithelial tumors (atypical proliferative [borderline] tumors or well-differentiated carcinomas of endometrioid or mucinous type). The endocervical tumors ranged in size from microscopic foci to 3 cm, with depth of invasion ranging from 0.2 to 1.5 cm; in 2 cases, the invasive foci qualified as microinvasive according to Federation Internationale de Gynecologie et d'Obstetrique staging criteria for cervical carcinoma. Adenocarcinoma in situ was identified in all tumors. In all cases, the paired endocervical and ovarian tumors contained identical HPV types. All evaluable tumors were diffusely positive for p16; and in 8 cases, there was absent or only limited expression of hormone receptors. Two of the minimally invasive endocervical tumors were initially interpreted as adenocarcinoma in situ and not recognized as unequivocally invasive even when evaluated in conjunction with the histologically identical ovarian tumors. HPV DNA detection in the ovarian tumors of 2 patients without known cervical disease led to discovery of occult cervical adenocarcinomas in those patients. Endocervical adenocarcinomas, including some qualifying as microinvasive, can metastasize to the ovaries and simulate primary ovarian surface epithelial neoplasms. The presence of HPV DNA in these ovarian tumors confirms that they are metastatic endocervical adenocarcinomas.
绝大多数宫颈管腺癌是高危型人乳头瘤病毒（HPV）相关肿瘤，其特征为p16表达以及激素受体表达常常缺失，很少转移至卵巢。我们报告了10例宫颈管腺癌伴卵巢转移的病例，其中卵巢肿瘤酷似原发性卵巢表面上皮肿瘤。评估HPV DNA的存在情况以确定卵巢肿瘤是转移瘤还是独立肿瘤。还进行了激素受体和p16的免疫组化检测。5例卵巢转移瘤与原发性宫颈管肿瘤同时出现，3例在宫颈管肿瘤之后出现，2例在宫颈管肿瘤诊断之前出现。卵巢肿瘤大小从2厘米至30厘米不等，7例肿瘤直径达10厘米或更大。8例卵巢肿瘤为单侧，2例为双侧。所有病例中，卵巢肿瘤最初均被诊断为或被认为代表原发性独立卵巢表面上皮肿瘤（非典型增生性[交界性]肿瘤或子宫内膜样或黏液样高分化癌）。宫颈管肿瘤大小从微小病灶至3厘米不等，浸润深度从0.2厘米至1.5厘米；根据国际妇产科联合会宫颈癌分期标准，2例病例中的浸润灶符合微浸润标准。所有肿瘤均发现原位腺癌。所有病例中，配对的宫颈管和卵巢肿瘤含有相同的HPV类型。所有可评估肿瘤p16均弥漫性阳性；8例病例中，激素受体表达缺失或仅为有限表达。2例微浸润性宫颈管肿瘤最初被诊断为原位腺癌，即使结合组织学相同的卵巢肿瘤进行评估，也未被明确识别为浸润性肿瘤。2例无已知宫颈疾病患者的卵巢肿瘤中检测到HPV DNA，从而发现了这些患者隐匿性宫颈管腺癌。宫颈管腺癌，包括一些符合微浸润标准的腺癌，可转移至卵巢并酷似原发性卵巢表面上皮肿瘤。这些卵巢肿瘤中HPV DNA的存在证实它们是转移性宫颈管腺癌。
