Department of Surgical Pathology, Stanford University School of Medicine, CA 94305, USA.
Am J Surg Pathol. 2012 May;36(5):688-95. doi: 10.1097/PAS.0b013e31824b6eed.
The role of endometriosis in ovarian cancer, disease progression, and survival is a subject of active investigation. A series of 144 ovarian cancers with clear cell or endometrioid histology or associated endometriosis, all classified on the basis of strict histologic criteria, was evaluated to further explore the relationship between endometriosis-associated ovarian cancer and age at presentation, FIGO stage, histology, presence of synchronous primary disease elsewhere in the mullerian tract, and survival. Patients with endometrioid carcinomas were significantly younger (mean, 52 y) in comparison with patients with either clear cell carcinoma (mean, 55 y) or mixed tumors (mean, 59 y; P=0.002). Clear cell carcinoma presented as low-stage disease (FIGO I) in 33% of cases compared with endometrioid carcinomas in 97% of cases and mixed carcinomas in 27% of cases. Endometriosis was associated with 53% of clear cell carcinomas, 33% of endometrioid carcinomas, and 45% of mixed tumors (P<0.001). Synchronous primary tumors, observed in 31% of endometrioid tumors, 5% of mixed tumors, and in 2% of clear cell tumors (P<0.001), were unlikely to be associated with endometriosis (P=0.04). Univariate analysis of the aggregate cohort demonstrated that the single best overall predictor of disease-free survival was FIGO stage at presentation (P<0.001), followed by histologic subtype (P=0.003). Endometriosis did not have a significant relationship with disease-free survival (P=0.7). We conclude that the link between endometriosis and ovarian cancer is much stronger for clear cell carcinoma than for other histologic subtypes (P<0.001). Furthermore, when uniform histologic criteria are applied, true mixed endometrioid and clear cell carcinomas are uncommon; most endometriosis-associated mixed tumors are heterogenous mixtures of endometrioid, mucinous, and serous histology with areas of clear cell cytoplasm. Endometriosis per se does not appear to predict prognosis in clear cell and endometrioid tumors, with the possible exception of tumors with mixed histology. Until more data are collected, pathologists should classify ovarian tumors with mixed histology as a separate and potentially unique biological and prognostic group.
子宫内膜异位症在卵巢癌的发生、疾病进展和生存中的作用是一个活跃的研究课题。对一系列 144 例具有透明细胞或子宫内膜样组织学或相关子宫内膜异位症的卵巢癌进行了评估，所有病例均根据严格的组织学标准进行分类，以进一步探讨与子宫内膜异位症相关的卵巢癌与发病年龄、FIGO 分期、组织学、同源性 Mullerian 管其他部位同步原发性疾病的存在以及生存之间的关系。子宫内膜样癌患者明显比透明细胞癌（55 岁）和混合性肿瘤（59 岁）患者年轻（平均年龄 52 岁）（P=0.002）。透明细胞癌 33%为低分期（FIGO I），而子宫内膜样癌 97%为低分期，混合性肿瘤 27%为低分期。子宫内膜异位症与 53%的透明细胞癌、33%的子宫内膜样癌和 45%的混合性肿瘤相关（P<0.001）。在 31%的子宫内膜样癌、5%的混合性肿瘤和 2%的透明细胞癌中观察到同步原发性肿瘤（P<0.001），与子宫内膜异位症无关（P=0.04）。对综合队列的单因素分析表明，疾病无进展生存的唯一最佳总体预测因子是就诊时的 FIGO 分期（P<0.001），其次是组织学亚型（P=0.003）。子宫内膜异位症与疾病无进展生存无显著相关性（P=0.7）。我们得出结论，子宫内膜异位症与卵巢癌的联系在透明细胞癌中比在其他组织学亚型中更强（P<0.001）。此外，当应用统一的组织学标准时，真正的混合性子宫内膜样和透明细胞癌并不常见；大多数与子宫内膜异位症相关的混合性肿瘤是子宫内膜样、黏液性和浆液性组织学的混合体，伴有透明细胞细胞质区域。子宫内膜异位症本身似乎并不能预测透明细胞癌和子宫内膜样癌的预后，除了混合组织学的肿瘤外。在收集更多数据之前，病理学家应将具有混合组织学的卵巢肿瘤分类为一个单独的、具有潜在独特生物学和预后的肿瘤组。
