McCluggage W G
Department of Pathology, Royal Group of Hospitals Trust, Grosvenor Road, Belfast BT126BL, Northern Ireland, UK.
J Clin Pathol. 2008 Feb;61(2):152-63. doi: 10.1136/jcp.2007.049478. Epub 2007 Aug 17.
Ovarian carcinomas of epithelial type comprise a heterogeneous group of neoplasms, each with a different underlying pathogenesis and natural behaviour. Accurate classification of ovarian carcinomas is important since each type may be associated with a different behaviour, natural history and outcome. Precise classification is also critical to determine whether alternative therapeutic strategies are appropriate for different tumour types. Previous studies have shown significant interobserver variation in the typing of ovarian carcinomas. There are several areas where there are particular difficulties; these include the distinction between high-grade serous and endometrioid adenocarcinomas and the distinction between a true clear cell carcinoma and clear cell areas within other adenocarcinomas. This review details my approach to the typing of ovarian carcinomas. Morphological assessment, which remains the mainstay in diagnosis, can be supplemented by immunohistochemistry which, for example, is useful in the distinction between serous carcinomas (WT1 positive) and other carcinomas (generally WT1 negative). In recent years, there has been emerging new information regarding the major underlying molecular events in several types of ovarian carcinoma. This has resulted in the acceptance that there are two distinct types of ovarian serous carcinoma. These are termed low-grade and high-grade serous carcinoma, but represent two distinct tumour types rather than low-grade and high-grade variants of the same neoplasm. The integration of clinical, morphological and molecular data has resulted in a more precise classification of ovarian carcinomas and has resulted in the proposal for a broad dualistic pathway of ovarian epithelial carcinogenesis with, in general, low-grade type 1 tumours evolving from benign and borderline neoplasms through a well-defined adenoma-carcinoma sequence, and high-grade type 2 neoplasms arising from an, as yet, undefined precursor lesion.
上皮型卵巢癌是一组异质性肿瘤，每种肿瘤都有不同的潜在发病机制和自然行为。准确分类卵巢癌很重要，因为每种类型可能与不同的行为、自然史和结局相关。精确分类对于确定不同的治疗策略是否适用于不同肿瘤类型也至关重要。先前的研究表明，在卵巢癌的分型上，观察者之间存在显著差异。有几个领域存在特别的困难；这些包括高级别浆液性癌和子宫内膜样腺癌之间的区分，以及真正的透明细胞癌与其他腺癌内透明细胞区域之间的区分。本综述详细介绍了我对卵巢癌分型的方法。形态学评估仍然是诊断的主要依据，可以通过免疫组织化学进行补充，例如，免疫组织化学有助于区分浆液性癌（WT1阳性）和其他癌（通常WT1阴性）。近年来，关于几种类型卵巢癌主要潜在分子事件的新信息不断涌现。这导致人们认识到存在两种不同类型的卵巢浆液性癌。它们被称为低级别和高级别浆液性癌，但代表两种不同的肿瘤类型，而不是同一肿瘤的低级别和高级别变体。临床、形态学和分子数据的整合导致了卵巢癌更精确的分类，并提出了卵巢上皮癌发生的广义二元途径，一般来说，低级别1型肿瘤通过明确的腺瘤-癌序列从良性和交界性肿瘤演变而来，高级别2型肿瘤则起源于尚未明确的前驱病变。
