Department of Pathology, University of Arizona, Tucson, 85724, USA.
Am J Surg Pathol. 2011 Jan;35(1):e1-e14. doi: 10.1097/PAS.0b013e318202772e.
Endometrial serous carcinomas constitute no more than 10% of endometrial adenocarcinomas, but frequently present at an advanced stage and have a significantly worse prognosis than the more common low-grade and intermediate-grade endometrioid adenocarcinomas. The neoplasm's potential for rapid tumor progression and the high mortality that is associated with advanced-stage disease underscore the importance of understanding endometrial serous carcinogenesis so that its precancers can be diagnosed and an effective therapeutic intervention can be administered. In this study, the authors summarize the current state of knowledge on endometrial serous carcinogenesis and propose a model for its development based on recent work from our group and published data from other researchers. In this model, endometrial serous carcinoma arises predominantly in the resting endometrium, manifesting first as p53 immunoreactive, morphologically normal endometrial cells (p53 signatures), evolving to endometrial glandular dysplasia (which is the first morphologically identifiable precursor lesion), then to serous endometrial intraepithelial carcinoma (a carcinoma with a noninvasive growth pattern in the uterus but which is not infrequently associated with extrauterine disease), and finally into fully developed serous carcinoma. Endometrial glandular dysplasia is a lesion, which can be diagnosed by routine microscopic evaluation, whose ablation or removal may potentially offer the opportunity to prevent the development of the associated malignancy. The diagnostic criteria, practical applicability, and evidentiary basis for the delineation of this lesion are studied.
子宫内膜浆液性癌构成不超过 10%的子宫内膜腺癌，但常出现于晚期，且预后显著差于更常见的低级别和中级别子宫内膜样腺癌。肿瘤具有快速进展的潜力，且晚期疾病相关的高死亡率突出强调了理解子宫内膜浆液性癌发生的重要性，以便诊断其癌前病变并进行有效的治疗干预。在这项研究中，作者总结了子宫内膜浆液性癌发生的现有知识状态，并基于我们小组的近期工作和其他研究人员的已发表数据提出了其发展模型。在该模型中，子宫内膜浆液性癌主要起源于静止期子宫内膜，最初表现为 p53 免疫反应性、形态正常的子宫内膜细胞（p53 特征），演变为子宫内膜腺体异型增生（这是首次可识别的形态前体病变），然后发展为子宫内膜浆液性上皮内癌（一种在子宫内具有非浸润性生长模式的癌，但通常与子宫外疾病相关），最终发展为完全成熟的浆液性癌。子宫内膜腺体异型增生是一种可通过常规显微镜评估诊断的病变，其消融或切除可能提供预防相关恶性肿瘤发展的机会。本研究探讨了该病变的诊断标准、实际适用性和证据基础。
