Department of Pathology, Belfast Health and Social Care Trust, Grosvenor Road, Belfast, Northern Ireland.
Am J Surg Pathol. 2011 Sep;35(9):1331-6. doi: 10.1097/PAS.0b013e3182233fce.
Primary ovarian mucinous carcinomas are uncommon and usually present as unilateral stage 1 neoplasms. The vast majority are of the so-called intestinal or enteric type and arise from a preexisting intestinal-type mucinous borderline neoplasm. The overall prognosis is good. However, a minor proportion recurs or metastasizes, and this is associated with a poor prognosis. The vast majority of primary ovarian intestinal-type mucinous carcinomas and borderline tumors exhibit a variable degree of positivity with enteric markers and are CA125 negative. The primary purpose of this study was to describe the unusual phenomenon of CA125 immunoreactivity in 8 of 10 metastatic mucinous carcinomas arising after a diagnosis of primary ovarian mucinous carcinoma (n=3) or mucinous borderline tumor of the intestinal type (n=7) in which the primary neoplasms were mostly negative. The reasons underlying this emergent CA125 positivity are not clear, but we speculate it may be because while intestinal type mucinous borderline neoplasms and mucinous carcinomas exhibiting so-called expansile invasion are usually CA125 negative, focal positivity may be seen in areas of infiltrative stromal invasion, which may preferentially metastasize. CA125 positivity in the metastatic neoplasm may result in the pathologist considering an alternative primary site; however, this should not be the case. In our study, we found a 4.2% risk of malignant progression after a diagnosis of primary ovarian mucinous borderline tumor of the intestinal type. In light of this, we favor retaining the term "mucinous borderline tumor," because of this small, but not insignificant, risk of malignant transformation, which in most cases is likely secondary to a focus of invasion being unsampled at the time of reporting the primary neoplasms.
原发性卵巢黏液性癌并不常见，通常表现为单侧Ⅰ期肿瘤。绝大多数为所谓的肠型或肠上皮型，来源于先前存在的肠型黏液性交界性肿瘤。总体预后良好。然而，少数会复发或转移，这与预后不良有关。绝大多数原发性卵巢肠型黏液性癌和交界性肿瘤表现出不同程度的肠型标志物阳性，且 CA125 阴性。本研究的主要目的是描述在诊断为原发性卵巢黏液性癌（n=3）或肠型黏液性交界性肿瘤（n=7）后发生的 10 例转移性黏液性癌中出现的 CA125 免疫反应性的罕见现象，其中 8 例原发性肿瘤大多为阴性。这种 CA125 阳性的出现原因尚不清楚，但我们推测可能是因为虽然肠型黏液性交界性肿瘤和黏液性癌表现出所谓的膨胀性浸润，通常 CA125 阴性，但在浸润性间质浸润的区域可能会出现局灶性阳性，这可能更容易转移。转移性肿瘤中 CA125 的阳性可能导致病理学家考虑替代的原发部位；然而，情况并非如此。在我们的研究中，我们发现诊断为肠型原发性卵巢黏液性交界性肿瘤后恶性进展的风险为 4.2%。有鉴于此，我们倾向于保留“黏液性交界性肿瘤”这一术语，因为存在这种小而不容忽视的恶性转化风险，在大多数情况下，这可能是由于在报告原发性肿瘤时未取样到侵袭灶。
