Tolcher Mary C, Swisher Elizabeth M, Medeiros Fabiola, Lima Joema F, Hilderbrand Jodi L, Donovan Janis L, Garcia Rochelle L, Cliby William A, Dowdy Sean C
Department of Obstetrics and Gynecology (M.C.T., W.A.C., S.C.D.), Division of Gynecologic Surgery Department of Laboratory Medicine and Pathology (F.M., J.F.L., J.L.H., J.L.D.), Mayo Clinic, Rochester, Minnesota Departments of Obstetrics and Gynecology (E.M.S.) Pathology (R.L.G.), Division of Gynecologic Oncology, University of Washington, Seattle, Washington.
Int J Gynecol Pathol. 2015 Jan;34(1):57-64. doi: 10.1097/PGP.0000000000000109.
To determine if selected cases of uterine serous carcinoma (USC) arise from tubal rather than endometrial epithelium. Bilateral fallopian tubes from 38 women with pure USC were entirely submitted for histopathologic examination using the protocol Sectioning and Extensively Examining the FIMbria (SEE-FIM). Non-neoplastic endometrium was extensively sampled. Immunohistochemistry for p53 was performed on all paraffin blocks of fallopian tube and non-neoplastic endometrium. Endometrial intraepithelial carcinoma (EIC) was present in 22 cases (58%). Endometrial p53 foci were identified in 3 patients. There were 11 cases (29%) with fallopian tube involvement; 9 of 11 had tubal wall invasion or lymphatic involvement without serous tubal intraepithelial carcinoma (STIC) and were, therefore, classified as metastatic from the endometrium. STIC was identified in 3 patients (8%). There were 3 cases with tubal p53 foci in non-neoplastic epithelium. EIC was present in 58% of patients, further supporting EIC as a precursor lesion to USC. STIC was present in 8%, suggesting that the fallopian tube may in fact represent the primary lesion in a minority of patients with USC. This finding may account for the early multifocal disease distribution observed in these patients.
为确定所选子宫浆液性癌（USC）病例是起源于输卵管上皮而非子宫内膜上皮。对38例纯USC患者的双侧输卵管全部按照输卵管伞端切片及广泛检查（SEE-FIM）方案进行组织病理学检查。对非肿瘤性子宫内膜进行广泛取材。对所有输卵管和非肿瘤性子宫内膜石蜡块进行p53免疫组化检测。22例（58%）存在子宫内膜上皮内癌（EIC）。3例患者发现子宫内膜p53病灶。11例（29%）有输卵管受累；11例中的9例有输卵管壁浸润或淋巴受累但无浆液性输卵管上皮内癌（STIC），因此被归类为子宫内膜转移。3例患者（8%）发现STIC。3例非肿瘤性上皮中有输卵管p53病灶。58%的患者存在EIC，进一步支持EIC作为USC的前驱病变。8%的患者存在STIC，提示输卵管实际上可能是少数USC患者的原发部位。这一发现可能解释了这些患者中观察到的早期多灶性疾病分布情况。
