Downes Michelle R, Allo Ghassan, McCluggage W Glenn, Sy Keiyan, Ferguson Sarah E, Aronson Melyssa, Pollett Aaron, Gallinger Steve, Bilbily Elaine, Shaw Pat, Clarke Blaise A
Department of Pathology, University Health Network, Toronto, ON, Canada.
Histopathology. 2014 Aug;65(2):228-39. doi: 10.1111/his.12386. Epub 2014 Apr 16.
Prophylactic hysterectomy with bilateral salpingo-oophorectomy is being increasingly undertaken in patients with Lynch syndrome (LS). The pathological features in such specimens are not well described and, unlike the SEE-FIM protocol for salpingo-oophorectomy specimens in BRCA1/2 mutation carriers and the gastrectomy grossing protocols for patients with CDH1 (E-cadherin) mutations, guidelines have not been devised for the grossing of prophylactic gynaecological specimens from LS patients. We aimed to review the pathological findings in a series of prophylactic gynaecological specimens from LS patients and develop guidelines for the grossing of these specimens.
We reviewed the pathological findings in 25 prophylactic gynaecological specimens from LS patients and audited the grossing protocols in different centres across Ontario, Canada. We found a 32% incidence of endometrial carcinoma or a precursor lesion; the two endometrial cancers identified were low-grade, low-stage endometrioid adenocarcinomas. To address the absence of guidelines for pathological examination, we undertook a literature review of gynaecological malignancies and incidental findings in prophylactic specimens in LS patients.
We provide recommendations regarding the grossing of such specimens which includes in-toto examination of the lower uterine segment, endometrium, ovaries and fallopian tubes with representative sampling of the cervix.
对于林奇综合征（LS）患者，预防性子宫切除术加双侧输卵管卵巢切除术的实施越来越多。此类标本的病理特征尚未得到充分描述，而且与针对BRCA1/2突变携带者输卵管卵巢切除标本的SEE-FIM方案以及CDH1（E-钙黏蛋白）突变患者的胃切除术大体标本处理方案不同，目前尚未制定针对LS患者预防性妇科标本大体标本处理的指南。我们旨在回顾一系列LS患者预防性妇科标本的病理结果，并制定这些标本大体标本处理的指南。
我们回顾了25例LS患者预防性妇科标本的病理结果，并审核了加拿大安大略省不同中心的大体标本处理方案。我们发现子宫内膜癌或癌前病变的发生率为32%；所发现的两例子宫内膜癌均为低级别、低分期的子宫内膜样腺癌。为了解决病理检查指南缺失的问题，我们对LS患者预防性标本中的妇科恶性肿瘤及偶然发现进行了文献综述。
我们提供了关于此类标本大体标本处理的建议，包括对子宫下段、子宫内膜、卵巢和输卵管进行整体检查，并对宫颈进行代表性取样。
