Pathology Department, Tabriz University of Medical Science, Tabriz, Iran.
Int J Gynecol Pathol. 2010 Mar;29(2):99-107. doi: 10.1097/PGP.0b013e3181bbbcc1.
Primary ovarian mucinous carcinomas of the intestinal type are uncommon and earlier reports have included cases diagnosed according to older, less stringent, criteria (which would now be considered borderline tumors) and variable numbers of cases of metastatic adenocarcinoma. This study was conducted to identify all cases of primary mucinous carcinoma of the ovary in a population-based registry, diagnosed according to WHO 2003 criteria, and to characterize their histologic features, immunohistochemical expression profile, and outcome. Thirty-one cases of primary ovarian mucinous carcinoma were included in this study. Immunostaining for 33 markers was performed. Mean age of the patients was 55.4+/-13.5 years. Thirty tumors were stage I or II at presentation. Twenty-six of 31 (83.9%) tumors had expansile stromal invasion, 4 of 31 (12.9%) showed destructive invasion, and 1 of 31 (3.2%) had anaplastic carcinoma in a mural nodule. All cases with destructive invasion showed grade 3 nuclear atypia whereas only 3 of 26 (11.5%) cases with expansile invasion had grade 3 nuclear atypia (P=0.0003). At follow-up, 6 of 26 patients (23.1%) with tumors showing expansile invasion experienced a recurrence, compared with 1 of 4 patients (25%) with destructive invasion and the single patient (100%) with anaplastic carcinoma. There was CK7 positivity in 26 of 31 cases (86.7%), and CK20 and Cdx-2 were each positive in 33.3% of cases. D2-40, calretinin, mesothelin, CA-125, Pax-8, TTF, and WT1 were completely negative in all cases. NHERF1 staining was present in 19 of 26 cases (73%) and its expression was associated with poor prognosis (P=0.05). Our findings support current diagnostic criteria for primary ovarian mucinous carcinoma, that is, the presence of expansile invasion, in the absence of destructive invasion, warrants a diagnosis of carcinoma. A large majority of mucinous carcinomas show only an expansile pattern of invasion and are confined to the pelvis at diagnosis.
原发性卵巢肠型黏液性癌较为罕见，早期报道的病例采用了较旧、较不严格的标准进行诊断（现在这些病例被认为是交界性肿瘤），并且转移性腺癌的病例数量也各不相同。本研究旨在通过基于人群的登记处，根据 WHO 2003 标准，确定所有原发性卵巢黏液性癌病例，并对其组织学特征、免疫组织化学表达谱和结局进行特征描述。本研究纳入了 31 例原发性卵巢黏液性癌病例。对 33 种标志物进行了免疫染色。患者的平均年龄为 55.4±13.5 岁。30 例肿瘤在初次诊断时处于Ⅰ期或Ⅱ期。26 例（83.9%）肿瘤有膨胀性间质浸润，31 例（12.9%）肿瘤有破坏性浸润，31 例（10.3%）肿瘤有一个壁结节的间变性癌。所有破坏性浸润的病例均有 3 级核异型性，而仅 26 例膨胀性浸润病例中的 3 例（11.5%）有 3 级核异型性（P=0.0003）。随访时，26 例有膨胀性浸润的肿瘤患者中有 6 例（23.1%）复发，而 4 例破坏性浸润的肿瘤患者中有 1 例（25%）复发，1 例间变性癌患者（100%）复发。26 例（86.7%）中有 CK7 阳性，33.3%的病例 CK20 和 Cdx-2 阳性。D2-40、钙视网膜蛋白、间皮素、CA-125、Pax-8、TTF 和 WT1 在所有病例中均完全阴性。NHERF1 染色在 26 例中的 19 例（73%）中存在，其表达与预后不良相关（P=0.05）。我们的研究结果支持原发性卵巢黏液性癌的现行诊断标准，即存在膨胀性浸润，而不存在破坏性浸润，应诊断为癌。大多数黏液性癌仅表现为膨胀性浸润模式，在初次诊断时局限于骨盆。
