Zaino Richard J
Milton S. Hershey Medical Center, Penn State University, Hershey, Pennsylvania.
Int J Gynecol Pathol. 2014 Jul;33(4):357-64. doi: 10.1097/PGP.0000000000000137.
Although most of Dr Scully's research addressed diseases of the ovary, about 10% of his published manuscripts focused on endometrial lesions, most often consisting of observations about unusual types or deceptive patterns of endometrial carcinoma that had not previously been described, or lesions for which the behavior had been unknown. He characterized and clarified the entity of clear cell carcinoma of the endometrium, and wrote about endometrial carcinomas with argyrophil, oxyphil, and giant cells, and those simulating microglandular hyperplasia of the cervix, as well as uterine papillary serous, squamous cell, and small cell carcinoma,. He provided a useful classification of precancers of the endometrium and also emphasized the relationship between estrogens and the development of some forms of uterine carcinoma. This article addresses the importance of his careful observations, focusing primarily on the potential relationship of 1 pattern of endometrial carcinoma that he described which has areas of microcystic, elongated, fragmented glands (MELF), frequently accompanied by a fibromyxoid or inflammatory stroma, to the recently described concept of epithelial mesenchymal transition. Endometrioid carcinomas with MELF frequently display a variety of immunohistochemical changes including reduced expression of E-cadherin, B-catenin, estrogen and progesterone receptors, Ki67, and overexpression of fascin, galactin-3, cyclin D1, and p16, as might be expected with epithelial mesenchymal transition. Additional studies will be needed to explain the significance of epithelial mesenchymal transition that occurs in carcinomas with regions of MELF.
虽然斯库利博士的大部分研究都围绕卵巢疾病展开，但他已发表的手稿中约10%聚焦于子宫内膜病变，其中大多是关于此前未被描述过的子宫内膜癌异常类型或具有欺骗性的模式的观察结果，或是行为尚不明确的病变。他对子宫内膜透明细胞癌的实体进行了特征描述和阐释，撰写了有关具有嗜银性、嗜酸性和巨细胞的子宫内膜癌，以及那些模拟宫颈微腺型增生的癌症，还有子宫乳头状浆液性癌、鳞状细胞癌和小细胞癌的文章。他给出了一个实用的子宫内膜癌前病变分类，还强调了雌激素与某些子宫癌发生发展之间的关系。本文论述了他细致观察的重要性，主要聚焦于他所描述的一种子宫内膜癌模式的潜在关系，该模式具有微囊状、细长、碎片化腺体（MELF）区域，常伴有纤维黏液样或炎性间质，与最近提出的上皮-间质转化概念相关。具有MELF的子宫内膜样癌常常呈现出多种免疫组化变化，包括E-钙黏蛋白、β-连环蛋白、雌激素和孕激素受体、Ki67表达降低，以及肌动蛋白、半乳糖凝集素-3、细胞周期蛋白D1和p16表达上调，这正如上皮-间质转化所预期的那样。还需要进一步的研究来解释在具有MELF区域的癌症中发生的上皮-间质转化的意义。
