Department of Laboratory Medicine, St Michaels Hospital, Toronto, ON, Canada.
Am J Surg Pathol. 2010 Aug;34(8):1132-8. doi: 10.1097/PAS.0b013e3181e6579c.
Poorly differentiated endometrial carcinomas of specific type include the rarely reported endometrial carcinoma with a malignant giant cell component [endometrial giant cell carcinoma (GCC)]. Since the initial description in 1991, there has only been 1 subsequent case report of this entity. We report another 5 cases. The patients ranged in age from 53 to 83 years, presenting with vaginal bleeding, anemia, or a pelvic mass. Four of the 5 tumors contained areas of endometrial adenocarcinoma of usual type, with a variable giant cell component. The conventional cell types present included 1 case with clear cell carcinoma (30% of tumor volume), 2 with high-grade endometrioid carcinoma (50% and 70% of tumor volume, respectively) and 1 with serous histology (10% of tumor volume). One was composed exclusively of giant cell carcinoma. The giant cell component in all cases consisted of poorly cohesive nests of bizarre multinucleated giant cells with mononuclear tumor cells. A striking peritumoral and intratumoral inflammatory cell infiltrate composed of lymphocytes, plasma cells and focal eosinophils, and neutrophils was present and emperipolesis was noted in 4 of the 5 cases. The giant cells showed focal staining for epithelial markers (AE1/AE3 and CAM 5.2). Three of the patients presented with stage 1A disease, 1 with stage 1B disease, and 1 tumor was advanced, presenting as stage IIIC2. One patient in whom the tumor was exclusively of the giant cell type, developed lung metastasis 4 years after diagnosis and 1 patient is disease free after 14 years. The remaining 3 patients showed no evidence of disease with 15 to 32 months of follow-up. As histotype supplemented by staging information is critical in selection of treatment modalities and in prognostication in uterine malignancies, accurate classification is mandated. Here, we present a series of endometrial carcinomas containing a component of GCC and discuss the spectrum of giant cell-containing uterine neoplasms. At this time, however, the cumulative data on endometrial GCC are limited and the prognostic significance of the presence and the extent of a giant cell component in endometrial carcinoma remains uncertain.
特定类型的低分化子宫内膜癌包括罕见报道的恶性巨细胞成分的子宫内膜癌（子宫内膜巨细胞癌[GCC]）。自 1991 年首次描述以来，仅有 1 例后续报道。我们报告了另外 5 例。患者年龄 53 至 83 岁，表现为阴道出血、贫血或盆腔肿块。5 例肿瘤中有 4 例含有通常类型的子宫内膜腺癌区域，并有可变的巨细胞成分。存在的常规细胞类型包括 1 例透明细胞癌（肿瘤体积的 30%）、2 例高级别子宫内膜样癌（肿瘤体积的 50%和 70%）和 1 例浆液组织学（肿瘤体积的 10%）。1 例完全由巨细胞癌组成。所有病例的巨细胞成分均由奇异多核巨细胞的松散巢组成，伴有单核肿瘤细胞。在所有病例中，存在引人注目的肿瘤周围和肿瘤内炎症细胞浸润，由淋巴细胞、浆细胞和局灶性嗜酸性粒细胞和中性粒细胞组成，并在 5 例中的 4 例中观察到 emperipolesis。巨细胞对上皮标志物（AE1/AE3 和 CAM 5.2）呈局灶性染色。3 例患者为 1A 期疾病，1 例为 1B 期疾病，1 例肿瘤为晚期，表现为 IIIC2 期。1 例肿瘤仅为巨细胞型的患者，在诊断后 4 年发生肺转移，1 例患者在 14 年后无疾病。在其余 3 例患者中，在随访 15 至 32 个月后，没有疾病证据。由于组织类型补充分期信息对于选择治疗方式和预测子宫恶性肿瘤的预后至关重要，因此需要进行准确的分类。在这里，我们介绍了一系列含有 GCC 成分的子宫内膜癌，并讨论了含有巨细胞的子宫肿瘤的范围。然而，目前关于子宫内膜 GCC 的累积数据有限，并且子宫内膜癌中巨细胞成分的存在和程度的预后意义尚不确定。
