Seidman Jeffrey D
Department of Pathology and Laboratory Medicine, Washington Hospital Center, Washington, District of Columbia.
Int J Gynecol Pathol. 2015 Mar;34(2):112-20. doi: 10.1097/PGP.0000000000000123.
Recent data suggest that intraepithelial carcinoma of the fallopian tube [serous tubal intraepithelial carcinoma (STIC)] is the precursor of high-grade extrauterine serous carcinoma. A more specific location for the origin of this lesion is suggested by the recently described junction between the fallopian tubal epithelium and the peritoneum [tubal-peritoneal junction (TPJ)]. Fallopian tubes from 202 patients with advanced-stage high-grade extrauterine serous carcinoma or carcinosarcoma were evaluated histologically as were 124 prophylactic salpingo-oophorectomy specimens. These included 54 patients with BRCA or other high-risk mutation or a family history of BRCA mutation and 70 with a personal or family history of breast carcinoma. STIC was found in 81 of 202 patients with serous carcinoma (40.1%). STIC was present in 73 of 141 (52%) cases in which the fimbriae were present and in 62 of 100 (62%) cases in which the TPJ was present (P not significant). In comparison with these groups, when fimbriae and TPJ were absent, STIC was found in 8 of 61 (13%) cases (P<0.0001). None of the prophylactic specimens contained STIC. The mean size of STIC was 1.7 mm. In 32 cases (39.5%), the lesion was flat and in 49 (60.5%), papillary. The mean size of flat STICs was 0.8 mm as compared with 2.3 mm for papillary STICs (P=0.00005). STIC was identified in the same tissue fragment as the junction in 48 cases. The mean distance of STIC to the junction was 1.8 mm. In 11 cases, STIC was flanked by peritoneal mesothelium on one side and tubal epithelium on the opposite side. In 51 patients, the mean distance of invasive carcinoma from the TPJ was 1.8 mm. This distance was 1.9 mm when STIC was present (37 cases) in comparison with 1.5 mm when STIC was absent (14 cases) (P not significant). In 27 of 42 cases (64%), STIC was contiguous with invasive carcinoma. Lamina propria invasion was present in 71% of cases in which STIC was present as compared with 26% of cases in which STIC was absent (P<0.0001). Myosalpingeal invasion was present in 40% of cases in which STIC was present as compared with 26% of cases in which STIC was absent (P not significant). It is concluded that serous tubal intraepithelial carcinoma occurs at and in the immediate vicinity of the TPJ. In combination with the findings that STICs are present in a majority of cases when the TPJ is present, that flat STICs are smaller than papillary STICs, and that lamina propria invasion is more frequent in the presence of STIC, these data support STIC as the precursor of extrauterine high-grade serous carcinoma, they provide important clues to the site of origin of high-grade serous carcinoma (ovarian cancer), and can guide further research.
近期数据表明，输卵管上皮内癌[浆液性输卵管上皮内癌（STIC）]是高级别宫外浆液性癌的前体。输卵管上皮与腹膜之间最近描述的交界处[输卵管 - 腹膜交界处（TPJ）]提示了该病变起源的更具体位置。对202例晚期高级别宫外浆液性癌或癌肉瘤患者的输卵管进行了组织学评估，同时也评估了124例预防性输卵管卵巢切除术标本。这些患者包括54例携带BRCA或其他高危突变或有BRCA突变家族史的患者以及70例有个人或家族乳腺癌病史的患者。在202例浆液性癌患者中，81例（40.1%）发现了STIC。在141例（52%）有伞端的病例中，73例存在STIC；在100例（62%）有TPJ的病例中，62例存在STIC（P无统计学意义）。与这些组相比，当不存在伞端和TPJ时，61例中有8例（13%）发现了STIC（P<0.0001）。所有预防性标本均未发现STIC。STIC的平均大小为1.7毫米。在32例（39.5%）病例中，病变为扁平状，49例（60.5%）为乳头状。扁平状STIC的平均大小为0.8毫米，乳头状STIC为2.3毫米（P = 0.00005）。在48例病例中，STIC在与交界处相同的组织切片中被识别。STIC与交界处的平均距离为1.8毫米。在11例病例中，STIC一侧为腹膜间皮，另一侧为输卵管上皮。在51例患者中，浸润性癌距TPJ的平均距离为1.8毫米。当存在STIC时（37例），此距离为1.9毫米；当不存在STIC时（14例），为1.5毫米（P无统计学意义）。在42例中的27例（64%）中，STIC与浸润性癌相邻。当存在STIC时，71%的病例存在固有层浸润，而不存在STIC时为26%（P<0.0001）。当存在STIC时，40%的病例存在输卵管肌层浸润，不存在STIC时为26%（P无统计学意义）。结论是浆液性输卵管上皮内癌发生在TPJ处及紧邻TPJ的区域。结合TPJ存在时大多数病例存在STIC、扁平状STIC比乳头状STIC小以及存在STIC时固有层浸润更常见这些发现，这些数据支持STIC作为宫外高级别浆液性癌的前体，它们为高级别浆液性癌（卵巢癌）的起源部位提供了重要线索，并可指导进一步研究。
