Department of Pathology and Laboratory Medicine, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22908, USA.
Int J Gynecol Pathol. 2010 Sep;29(5):445-51. doi: 10.1097/PGP.0b013e3181d81de6.
Depth of myometrial invasion by endometrioid adenocarcinoma (EMAC) is one of the most important predictive factors of disease recurrence. It is unclear whether myoinvasion arising in carcinomatous involvement of adenomyosis (AM) changes prognosis. The purpose of this study was to evaluate the significance and frequency of the tumor involved AM in otherwise low-stage cancers. Eighty-two hysterectomies with EMAC with less than 50% myoinvasion (T1a, FIGO IA), AM, and at least 2 years of follow-up information were reviewed. The tumors were divided into 4 histologic groups: group 1, no involvement of AM by EMAC (n=38); group 2, tumor involved AM surrounded by endometrial stroma (n=31); group 3, tumor involved AM with incomplete peripheral endometrial stroma (n=10); and group 4, tumor involved AM with invasion into adjacent smooth muscle (n=3). Tumor involved AM was in the inner half of the myometrium in 35 cases and in the outer half of the myometrium in 9 cases. The only adverse outcome was vaginal recurrence, which was noted in 2 of 82 patients; both the patients were from the control group. None of the patients with deep-seated tumor involved AM had tumor recurrence. In otherwise low-stage tumors, our data support the concept that tumor involvement of the deeply located AM does not affect prognosis. Myometrial-based foci of well-differentiated EMAC, completely or partially surrounded by endometrial stroma, most likely represents tumor colonized AM. Determining invasion out of these foci is subjective, and although limited by rarity in this study, carries no adverse outcome. Therefore, staging should be based on the myoinvasion noted at the native endomyometrial junction.
子宫内膜样腺癌（EMAC）的肌层浸润深度是疾病复发的最重要预测因素之一。癌性累及腺肌病（AM）的肌内浸润是否改变预后尚不清楚。本研究旨在评估在其他低分期癌症中肿瘤累及 AM 的意义和频率。回顾了 82 例肌层浸润小于 50%（FIGO IA）、AM 和至少 2 年随访信息的 EMAC 子宫切除术。将肿瘤分为 4 个组织学组：组 1，EMAC 无 AM 累及（n=38）；组 2，肿瘤累及 AM 被子宫内膜间质环绕（n=31）；组 3，肿瘤累及 AM 伴不完全周围子宫内膜间质（n=10）；组 4，肿瘤累及 AM 伴邻近平滑肌浸润（n=3）。肿瘤累及 AM 位于肌层内 1/2 有 35 例，位于肌层外 1/2 有 9 例。唯一不良结局为阴道复发，82 例患者中有 2 例；这两名患者均来自对照组。深部肿瘤累及 AM 的患者无一例肿瘤复发。在其他低分期肿瘤中，我们的数据支持肿瘤累及深部 AM 不影响预后的概念。完全或部分被子宫内膜间质包围的深部位置 AM 中分化良好的子宫内膜样腺癌的肌内病灶，最有可能代表肿瘤定植的 AM。确定这些病灶之外的浸润是主观的，尽管本研究中由于罕见而受到限制，但没有不良后果。因此，分期应基于原始内膜肌层交界处的肌层浸润。
