Kim Kyu-Rae, Lee Hyang-Im, Lee Seung-Koo, Ro Jae Y, Robboy Stanley J
Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Am J Surg Pathol. 2007 Apr;31(4):546-54. doi: 10.1097/01.pas.0000213430.68998.2c.
Stromal microinvasion has been recently described in ovarian mucinous borderline tumors (MBTs), leading to proposals for new classifications, including a category of MBTs with stromal microinvasion. This study was conducted to test the validity of this belief. To determine whether stromal microinvasion can be distinguishable from extruded neoplastic epithelium from an adjacent ruptured gland, particularly if accompanied by a mucin granuloma (MG) on hematoxylin and eosin (H&E)-stained sections, we compared the histopathologic features of 138 primary ovarian mucinous tumors, consisting of 81 MBTs, 37 MBTs with stromal microinvasion, 11 intraglandular carcinomas, 2 with microinvasive foci, and 7 mucinous adenocarcinomas with extensive stromal invasion. Immunohistochemical analysis for cytokeratin was performed in 72 cases. Of 77 cases containing MGs, 52% contained "microinvasive foci," consisting of individually scattered epithelial or irregular glandular components in the intervening stroma, as determined by H&E staining. Of the 37 negative cases on H&E, cytokeratin reactivity was detected in 15 additional cases with epithelial/glandular components. Therefore, "stromal microinvasion" can be missed on H&E. All patients with MBT with or without microinvasive foci and localized intraglandular carcinoma with or without microinvasive foci had stage I tumors; none died of tumor-related causes during the follow-up period. Tumor-related deaths were identified only in 5 patients with extensive stromal invasion. This study suggests that some cases of stromal microinvasion in stage I MBTs not accompanied by high grade nuclear atypia represent mucocele-like stromal reaction to ruptured mucinous glands rather than true stromal invasion because isolated tumor cells were exclusively confined to the boundary of MGs and devoid of obvious cellular atypia, and no patient with stromal microinvasion died of tumor-related causes.
最近在卵巢黏液性交界性肿瘤（MBTs）中发现了间质微浸润，这促使人们提出新的分类方法，包括一类伴有间质微浸润的MBTs。本研究旨在验证这一观点的正确性。为了确定间质微浸润是否能与相邻破裂腺体挤出的肿瘤上皮区分开来，特别是在苏木精和伊红（H&E）染色切片上伴有黏液肉芽肿（MG）的情况下，我们比较了138例原发性卵巢黏液性肿瘤的组织病理学特征，其中包括81例MBTs、37例伴有间质微浸润的MBTs、11例腺内癌、2例伴有微浸润灶的肿瘤以及7例伴有广泛间质浸润的黏液腺癌。对72例病例进行了细胞角蛋白免疫组织化学分析。在77例含有MG的病例中，52%含有“微浸润灶”，根据H&E染色，这些微浸润灶由间质中单个散在的上皮或不规则腺性成分组成。在H&E染色为阴性的37例病例中，另外15例含有上皮/腺性成分的病例检测到细胞角蛋白反应性。因此，H&E染色可能会漏诊“间质微浸润”。所有伴有或不伴有微浸润灶的MBT患者以及伴有或不伴有微浸润灶的局限性腺内癌患者均为I期肿瘤；随访期间无一例死于肿瘤相关原因。仅在5例伴有广泛间质浸润的患者中发现了肿瘤相关死亡。本研究表明，I期MBTs中一些不伴有高级别核异型性的间质微浸润病例代表了对破裂黏液性腺的黏液囊肿样间质反应，而非真正的间质浸润，因为孤立的肿瘤细胞仅局限于MG边界，且无明显细胞异型性，并且没有间质微浸润患者死于肿瘤相关原因。
