Department of Pathology, Women and Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA.
Mod Pathol. 2011 Sep;24(9):1254-61. doi: 10.1038/modpathol.2011.78. Epub 2011 May 13.
Tubal metaplasia of the endometrium may occasionally display cytologic atypia (atypical tubal metaplasia) resembling serous carcinoma or endometrial intraepithelial carcinoma. Although atypical tubal metaplasia is presumed to be reactive or degenerative in etiology, its clinical significance is unknown. In this study, we investigated atypical tubal metaplasia in regard to its immunoexpression of p53, Ki-67, and human telomerase reverse transcriptase (TERT), and its long-term clinical outcome. A total of 63 cases of atypical tubal metaplasia and 200 cases of endometrial samples with typical tubal metaplasia were followed for a mean of 64 and 61 months, respectively. Of the 63 atypical tubal metaplasia cases, formalin-fixed, paraffin-embedded tissue sections from 16 cases were immunostained with antibodies to p53, Ki-67, and TERT. Sections from 13 cases of uterine serous carcinoma were also stained for TERT as control. After long-term follow-up, 5% of patients in the atypical tubal metaplasia group developed hyperplasia without atypia compared with 4% of patients in the control group (P=0.44), whereas 3% in the atypical tubal metaplasia group developed atypical hyperplasia or carcinoma compared with 2% in the control group (P=0.44). p53 immunoreactivity was either focal and weak or negative in all cases of both atypical and typical tubal metaplasia (P>0.05). Ki-67 immunoreactivity was present in 0-5% of cells in 94% of both atypical and typical tubal metaplasia (P>0.05). TERT immunoexpression was absent in all 16 cases of atypical tubal metaplasia, but present in all 13 cases of uterine serous carcinoma (P<0.0001). Our study indicates that atypical tubal metaplasia displays an immunostaining pattern similar to otherwise typical tubal metaplasia of the endometrium, and distinct from uterine serous neoplasms. The presence of atypical tubal metaplasia in endometrial samplings does not increase the risk of developing endometrial hyperplasia or malignancy.
子宫内膜的输卵管上皮化生偶尔可能会表现出细胞学异型性（非典型输卵管上皮化生），类似于浆液性癌或子宫内膜上皮内癌。虽然非典型输卵管上皮化生在病因学上被认为是反应性或退行性的，但它的临床意义尚不清楚。在这项研究中，我们研究了非典型输卵管上皮化生的 p53、Ki-67 和人端粒酶逆转录酶（TERT）的免疫表达及其长期临床结果。总共对 63 例非典型输卵管上皮化生和 200 例有典型输卵管上皮化生的子宫内膜样本进行了随访，平均随访时间分别为 64 个月和 61 个月。在 63 例非典型输卵管上皮化生病例中，对 16 例福尔马林固定、石蜡包埋组织切片用 p53、Ki-67 和 TERT 抗体进行了免疫染色。对 13 例子宫浆液性癌的组织切片也进行了 TERT 染色作为对照。经过长期随访，非典型输卵管上皮化生组中有 5%的患者发展为非典型增生而无增生，而对照组中有 4%（P=0.44）；非典型输卵管上皮化生组中有 3%的患者发展为不典型增生或癌，而对照组中有 2%（P=0.44）。在所有非典型和典型输卵管上皮化生病例中，p53 免疫反应要么是局灶性和弱的，要么是阴性（P>0.05）。Ki-67 免疫反应在 94%的非典型和典型输卵管上皮化生病例中存在于 0-5%的细胞中（P>0.05）。在所有 16 例非典型输卵管上皮化生病例中，TERT 免疫表达均为阴性，但在所有 13 例子宫浆液性癌病例中均为阳性（P<0.0001）。我们的研究表明，非典型输卵管上皮化生表现出与子宫内膜其他典型输卵管上皮化生相似的免疫染色模式，与子宫浆液性肿瘤不同。在子宫内膜样本中出现非典型输卵管上皮化生并不会增加发展为子宫内膜增生或恶性肿瘤的风险。
