Kos Zuzana, Broaddus Russell R, Djordjevic Bojana
Department of Pathology and Laboratory Medicine (Z.K., B.D.), University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada Department of Pathology (R.R.B.), MD Anderson Cancer Center, University of Texas, Houston, Texas.
Int J Gynecol Pathol. 2014 Jul;33(4):443-8. doi: 10.1097/PGP.0b013e31829c728b.
For the first time, we report a case of a primary high-grade serous carcinoma of the fallopian tube in a 69-yr-old woman with intraepithelial involvement of endocervical glands. The patient had a remote history of tubal ligation and no known personal or family history of breast or gynecologic cancer. She initially presented with an abnormal Pap smear, and, on a subsequent endometrial curettage, detached fragments of high-grade adenocarcinoma were identified. Upon hysterectomy and bilateral salpingoophorectomy, invasive high-grade serous carcinoma was found in the proximal stump of a ligated fallopian tube. Morphologically identical tumor extensively involved the endocervical glands. A single focus of malignant cells was also found at the surface of the lower uterine segment endometrium. By immunohistochemistry, the tumors in the fallopian tube and in the cervix showed the same immunopheonotype. This included diffuse staining for WT-1, PAX-8, p16, and p53, and focal staining for the monoclonal carcinoembryonic antigen. The estrogen receptor was negative. Human papillomavirus-in situ hybridization was also negative. The focus of intramucosal tumor within the endometrium was similarly positive for WT-1 and p53 and negative for the estrogen receptor. The patient was subsequently treated with 6 cycles of carboplatinum and taxol. She remains well with no evidence of recurrent disease. The phenomenon of intramucosal tumor spread to the cervix mimicking primary invasive or in situ cervical adenocarcinoma may present a diagnostic challenge for the pathologist, requiring consideration of an appropriately wide differential diagnosis when interpreting cervical cytology and endocervical and endometrial biopsies.
我们首次报告了一例69岁女性的原发性高级别输卵管浆液性癌，宫颈腺上皮有受累情况。该患者有输卵管结扎史，无已知的个人或家族乳腺癌或妇科癌症病史。她最初因巴氏涂片异常就诊，随后子宫内膜刮宫术发现了高级别腺癌的脱落碎片。子宫切除及双侧输卵管卵巢切除术后，在结扎输卵管的近端残端发现了浸润性高级别浆液性癌。形态学上相同的肿瘤广泛累及宫颈腺。在子宫下段子宫内膜表面也发现了单个恶性细胞灶。免疫组化显示，输卵管和宫颈的肿瘤具有相同的免疫表型。这包括WT-1、PAX-8、p16和p53的弥漫性染色，以及单克隆癌胚抗原的局灶性染色。雌激素受体为阴性。人乳头瘤病毒原位杂交也为阴性。子宫内膜内黏膜下肿瘤灶WT-1和p53同样呈阳性，雌激素受体为阴性。该患者随后接受了6个周期的卡铂和紫杉醇治疗。她目前情况良好，无疾病复发迹象。黏膜下肿瘤扩散至宫颈，酷似原发性浸润性或原位宫颈腺癌的现象，可能给病理学家带来诊断挑战，在解读宫颈细胞学及宫颈管和子宫内膜活检结果时，需要考虑进行全面的鉴别诊断。
