Zheng Wenxin, Liang Sharon X, Yi Xiaofang, Ulukus E Cagnur, Davis John R, Chambers Setsuko K
Department of Pathology, College of Medicine University of Arizona, Tucson, Arizona, USA.
Int J Gynecol Pathol. 2007 Jan;26(1):38-52. doi: 10.1097/01.pgp.0000228138.56222.4e.
Endometrial glandular dysplasia (EmGD) is a newly defined entity that is commonly and specifically associated with serous endometrial intraepithelial carcinoma and uterine papillary serous carcinoma (UPSC). Endometrial glandular dysplasia has been proposed as a true precancerous lesion of UPSC based on our recent studies showing morphological and molecular linkages between these 2 lesions. The present report is to examine if EmGD occurs before UPSC development and to define the period from the occurrence of EmGD to a full-blown UPSC by studying their clinicopathologic features in a retrospective setting. A total of 250 UPSC and 258 benign cases were used as initial study source. To identify if EmGD existed before the development of UPSC, we blindly reviewed all available endometrial biopsies from a period of 3 months or earlier before hysterectomies. These included an available pool of 27 biopsy specimens from UPSC group and 29 samples from benign control group. Any endometrial abnormalities, which morphologically qualified as EmGD as defined previously in preceding biopsies were recorded. Among all endometrial biopsies before hysterectomies, we morphologically identified a total of 10 EmGD cases; 9 (33%) of 27 were from UPSC group and 1 (3.5%) of 29 were from benign control group. All 10 morphologically diagnosed EmGD cases showed a high p53 staining score (>/=5) except 1 noncontributory from UPSC group and 1 from the benign control group with a score of 0. A high MIB-1 index score was seen in all EmGD cases, whereas low index was found in morphologically benign biopsies. The main purpose of this study is to report these retrospectively identified EmGD cases. The period from identifying EmGD to the presence of either a serous endometrial intraepithelial carcinoma or a full-blown UPSC ranged from 16 to 98 months with an average of 33 months. We conclude that occurrence of EmGD precedes the development of UPSC. The findings support our recently proposed UPSC development model, in which EmGD is likely to be a precursor lesion of UPSC. Further studies are needed to address issues in regard to molecular and cellular mechanisms, reversibility, risk of UPSC development, and clinical management of EmGD.
子宫内膜腺体发育异常（EmGD）是一种新定义的病变，通常且特异性地与浆液性子宫内膜上皮内癌及子宫乳头状浆液性癌（UPSC）相关。基于我们最近的研究显示这两种病变之间的形态学和分子联系，子宫内膜腺体发育异常已被提出是UPSC真正的癌前病变。本报告旨在通过回顾性研究其临床病理特征，来检验EmGD是否在UPSC发生之前出现，并确定从EmGD出现到发展为典型UPSC的时间段。总共250例UPSC病例和258例良性病例作为初始研究来源。为了确定在UPSC发生之前EmGD是否存在，我们对子宫切除术前3个月或更早时期的所有可用子宫内膜活检标本进行了盲法回顾。这些标本包括来自UPSC组的27份活检标本和来自良性对照组的29份样本。记录所有在形态学上符合先前活检中定义的EmGD的子宫内膜异常情况。在所有子宫切除术前的子宫内膜活检标本中，我们在形态学上共识别出10例EmGD病例；27例中有9例（33%）来自UPSC组，29例中有1例（3.5%）来自良性对照组。除了UPSC组1例无诊断意义的病例和良性对照组1例评分为0的病例外，所有10例经形态学诊断的EmGD病例均显示p53染色评分高（≥5）。所有EmGD病例均可见高MIB-1指数评分，而形态学上为良性的活检标本中指数较低。本研究的主要目的是报告这些通过回顾性研究识别出的EmGD病例。从识别出EmGD到出现浆液性子宫内膜上皮内癌或典型UPSC的时间段为16至98个月，平均为33个月。我们得出结论，EmGD的发生先于UPSC的发展。这些发现支持了我们最近提出的UPSC发展模型，即EmGD可能是UPSC的前驱病变。需要进一步研究来解决有关分子和细胞机制、可逆性、UPSC发生风险以及EmGD临床管理等问题。
