McKenney Jesse K, Balzer Bonnie L, Longacre Teri A
Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA.
Am J Surg Pathol. 2006 May;30(5):614-24. doi: 10.1097/01.pas.0000194743.33540.e6.
The occurrence of regional lymph node involvement (LNI) in patients with primary ovarian serous tumors of low malignant potential (S-LMP), although well described in the literature, continues to be problematic. Most studies indicate that LNI is not associated with an adverse prognosis, but there has not been a comprehensive study addressing the histologic patterns of LNI, the importance, if any, of classifying the type of LNI (ie, as either noninvasive or invasive in analogy to peritoneal implant classification), or the presence and significance of associated endosalpingiosis. To further evaluate LNI in S-LMP, 74 patients with ovarian S-LMP and a lymph node biopsy or sampling were studied. Thirty-one of 74 patients had LNI in pelvic (18; 58%), mesenteric/omental (9; 29%), paraaortic (8; 26%), or supradiaphragmatic (2; 6%) lymph nodes. The number of involved nodes ranged from 1 to 20 (mean, 11.1). Four patterns of LNI were identified: individual cells, clusters of cells, and simple, nonbranching papillae (28 of 31; 90%); intraglandular (21 of 31; 68%); cells with prominent cytoplasmic eosinophilia ("eosinophilic cell" pattern) (16 of 31; 52%); and micropapillary pattern (5 of 31; 16%). LNI was diffuse in at least one lymph node in 13 patients (42%) and formed nodular aggregates greater than 1 mm in 6 patients (19%). Nodal endosalpingiosis was present in 58% of cases with LNI compared with 35% without LNI (P=0.06). There was no significant difference in survival for patients with LNI compared with patients without LNI. However, the presence of discrete nodular aggregates of epithelium greater than 1 mm in linear dimension without intervening lymphoid tissue was associated with a statistically significant decreased disease-free survival when compared with other patterns of LNI (P=0.02). Nodular aggregates were strongly associated with desmoplastic fibrous stromal reaction (P=0.001) and micropapillary architecture (0.02). There was also a trend for decreased survival among patients with LNI without associated endosalpingiosis (56%) compared with patients with LNI associated with endosalpingiosis (85%) and those with endosalpingiosis only (93%). This study suggests that patients with ovarian S-LMP may be further substratified into risk categories by the presence of nodular aggregates of S-LMP in lymph nodes, a feature that is more common in cases with micropapillary architecture and associated stromal reaction in the intranodal tumor. This high risk pattern of LNI may have a predictive value similar to invasive peritoneal implants and deserves independent evaluation in future studies of S-LMP.
原发性低恶性潜能卵巢浆液性肿瘤（S-LMP）患者区域淋巴结受累（LNI）的情况，尽管文献中已有充分描述，但仍是个问题。大多数研究表明，LNI与不良预后无关，但尚未有全面研究探讨LNI的组织学模式、LNI类型分类（即类似于腹膜种植分类分为非侵袭性或侵袭性）的重要性（若有），或相关输卵管内膜异位的存在及意义。为进一步评估S-LMP中的LNI，对74例接受淋巴结活检或取样的卵巢S-LMP患者进行了研究。74例患者中有31例出现盆腔（18例；58%）、肠系膜/网膜（9例；29%）、腹主动脉旁（8例；26%）或膈上（2例；6%）淋巴结LNI。受累淋巴结数量为1至20个（平均11.1个）。确定了四种LNI模式：单个细胞、细胞簇以及简单的无分支乳头（31例中的28例；90%）；腺内型（31例中的21例；68%）；胞质嗜酸性显著的细胞（“嗜酸性细胞”模式）（31例中的16例；52%）；以及微乳头模式（31例中的5例；16%）。13例患者（42%）至少一个淋巴结中的LNI呈弥漫性，6例患者（19%）形成直径大于1mm的结节状聚集。LNI病例中58%存在淋巴结输卵管内膜异位，而无LNI病例中这一比例为35%（P=0.06）。有LNI的患者与无LNI的患者生存率无显著差异。然而，与其他LNI模式相比，线性维度大于1mm且无中间淋巴组织的离散上皮结节状聚集的存在与无病生存率在统计学上显著降低相关（P=0.02）。结节状聚集与促纤维组织增生性纤维间质反应密切相关（P=0.001）和微乳头结构（P=0.02）。与伴有输卵管内膜异位的LNI患者（85%）和仅伴有输卵管内膜异位的患者（93%）相比，无相关输卵管内膜异位的LNI患者（56%）生存率也有下降趋势。这项研究表明，卵巢S-LMP患者可根据淋巴结中S-LMP的结节状聚集进一步分层为风险类别，这一特征在微乳头结构和淋巴结内肿瘤相关间质反应的病例中更为常见。这种高风险的LNI模式可能具有与侵袭性腹膜种植相似的预测价值，值得在未来S-LMP研究中进行独立评估。
