Ismiil Nadia, Rasty Golnar, Ghorab Zeina, Nofech-Mozes Sharon, Bernardini Marcus, Ackerman Ida, Thomas Gillian, Covens Allan, Khalifa Mahmoud A
Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5.
Ann Diagn Pathol. 2007 Aug;11(4):252-7. doi: 10.1016/j.anndiagpath.2006.08.011.
Adenomyosis is commonly seen in association with endometrial adenocarcinoma where it may or may not be involved by malignancy. This study of grade 1 endometrioid adenocarcinoma investigates whether patients with cancer-positive adenomyosis are at a different risk for deep myometrial invasion compared with those with cancer-negative adenomyosis. Ninety-three hysterectomy specimens with FIGO (International Federation of Gynecologists and Obstetricians) grade 1 endometrial endometrioid adenocarcinoma associated with adenomyosis were studied. Four experienced gynecologic pathologists retrospectively reviewed all hematoxylin and eosin-stained sections. Myometrial invasion was confirmed by CD10-negative staining around glands with jagged outline surrounded by inflamed desmoplastic stroma. Adenomyosis was involved by adenocarcinoma in 46 cases, whereas it was carcinoma-negative in 47 cases. Myometrial invasion was found in significantly more carcinoma-positive adenomyosis cases (n = 42, 91.3%) than with carcinoma-negative adenomyosis cases (n = 30, 63.8%) (chi(2) = 12.10; P = .0005). Moreover, myometrial invasion in the outer half was also seen in significantly more carcinoma-positive adenomyosis cases (n = 16, 34.8%) than with carcinoma-negative adenomyosis cases (n = 3, 6.4%) (chi(2) = 11.53; P = .0007). Among all cases of FIGO grade 1 endometrial endometrioid adenocarcinoma associated with adenomyosis, the ones that extend in the adenomyosis gain more invasive advantage, probably through increasing the surface area of its interface with the adjacent myometrium. When compared with tumors that do not involve adenomyosis, these tumors are not only more likely to invade the myometrium but are significantly more prone to achieve deep invasion into the outer half.
子宫腺肌病常与子宫内膜腺癌相关，腺癌可能累及也可能未累及子宫腺肌病。本研究针对1级子宫内膜样腺癌，探究癌累及子宫腺肌病的患者与癌未累及子宫腺肌病的患者相比，发生子宫肌层深部浸润的风险是否不同。研究了93例伴有子宫腺肌病的国际妇产科联盟（FIGO）1级子宫内膜样腺癌的子宫切除标本。4名经验丰富的妇科病理学家对所有苏木精和伊红染色切片进行了回顾性检查。通过CD10阴性染色确认子宫肌层浸润，腺体周围轮廓参差不齐，周围伴有炎性促纤维增生性间质。46例子宫腺肌病被腺癌累及，47例为癌未累及。癌累及子宫腺肌病的病例中发生子宫肌层浸润的显著多于癌未累及子宫腺肌病的病例（n = 42，91.3% 对比 n = 30，63.8%）（χ² = 12.10；P = .0005）。此外，癌累及子宫腺肌病的病例中外半肌层浸润也显著多于癌未累及子宫腺肌病的病例（n = 16，34.8% 对比 n = 3，6.4%）（χ² = 11.53；P = .0007）。在所有伴有子宫腺肌病的FIGO 1级子宫内膜样腺癌病例中，那些在子宫腺肌病中蔓延的病例获得了更强的侵袭优势，可能是通过增加其与相邻子宫肌层界面的表面积。与未累及子宫腺肌病的肿瘤相比，这些肿瘤不仅更易侵入子宫肌层，而且显著更易向外半肌层深部浸润。
