Department of Cellular Pathology, Barts and the London NHS Trust, London, UK.
Histopathology. 2010 Feb;56(3):277-85. doi: 10.1111/j.1365-2559.2009.03367.x.
About 1-2% of women with gynaecological cancers are found to have two or more simultaneous independent primary malignancies. Low stage multiple primaries must be distinguished from metastasis from one to other site for correct management. Synchronous tumours in the ovary and endometrium are the commonest combination. Most of these can be accurately categorised by standard histological criteria. Molecular testing has been advocated for valuable adjunctive information in ambiguous cases but must be interpreted with clinicopathological correlation: loss of heterozygosity, pTEN or beta-catenin gene mutational analysis, microsatellite instability and most recently gene expression profiling have all been used. The pattern of beta-catenin immunohistochemical expression has been reported to be of value. A very low percentage of women with synchronous primaries in the uterus and ovary are HNPCC patients and testing for mismatch repair gene mutations is unnecessary in all cases, even if young; the diagnosis of HNPCC should be based on standard criteria. Women with endometrial cancer under 50 are more likely than older patients to have a synchronous ovarian cancer. Rarer combinations of synchronous tumours are less well studied but may also represent a mixture of unusual patterns of metastasis and multifocal origin; these are discussed briefly.
约 1-2%的妇科癌症患者被发现同时患有两种或多种独立的原发性恶性肿瘤。低分期的多发病灶必须与从一个部位转移到另一个部位的转移区分开来，以便正确管理。卵巢和子宫内膜的同步肿瘤是最常见的组合。其中大多数可以通过标准组织学标准准确分类。分子检测已被提倡用于在模棱两可的情况下提供有价值的辅助信息，但必须与临床病理相关性进行解释：杂合性丢失、pTEN 或β-连环蛋白基因突变分析、微卫星不稳定性，最近还有基因表达谱分析都已被使用。β-连环蛋白免疫组化表达模式已被报道具有价值。极少数同时患有子宫和卵巢原发性肿瘤的女性是 HNPCC 患者，即使年轻，也不需要对所有病例进行错配修复基因突变检测；HNPCC 的诊断应基于标准标准。50 岁以下患有子宫内膜癌的女性比老年患者更有可能同时患有卵巢癌。同步肿瘤的罕见组合研究较少，但也可能代表不同转移模式和多灶性起源的混合；这些将简要讨论。
