Joehlin-Price Amy S, McHugh Kelsey E, Stephens Julie A, Li Zaibo, Backes Floor J, Cohn David E, Cohen David W, Suarez Adrian A
*Department of Pathology †Center for Biostatistics ‡Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH.
Am J Surg Pathol. 2017 Jan;41(1):49-55. doi: 10.1097/PAS.0000000000000754.
MELF invasion has been associated with nonvaginal recurrences and lymph node (LN) metastases in multi-institutional case control studies but has not been well examined in large single-institution cohorts. Hysterectomy specimens with FIGO 1 endometrioid endometrial carcinoma and lymphadenectomies from 2007 to 2012 were identified. Electronic medical records and histologic slides were reviewed. Of 464 identified cases, 163 (35.1%) were noninvasive, 60 (12.9%) had MELF, 222 (47.8%) had a component of the infiltrative invasion pattern without MELF, 13 (2.8%) had pure pushing borders of invasion, 5 (1.1%) had pure adenomyosis-like invasion, and 1 (0.2%) had pure adenoma malignum-like invasion. Sixteen cases had LN metastases. Significantly more MELF cases had positive LNs than non-MELF cases overall (18.3% vs. 1.2%, P<0.001). The results were almost identical when invasive infiltrative cases with and without MELF were compared (18.3% vs. 1.8%, P<0.001). The maximum number of MELF glands per slide did not differ between cases with and without LN metastases, P=0.137. A majority of positive LNs, even in MELF cases, demonstrated nonhistiocyte-like metastases. Only 5 cases (all with MELF invasion) demonstrated micrometastatic lesions or isolated tumor cells only. MELF cases demonstrated a nonsignificant decrease in time to extravaginal recurrence (P=0.082, log-rank test), for which analysis was limited by low recurrence rates. In summary, MELF is associated with LN metastases, even when compared with other infiltrative cases and shows multiple patterns of growth in positive LNs. MELF cases additionally trended toward decreased time to extravaginal recurrence.
在多机构病例对照研究中，微乳头样（MELF）浸润与非阴道复发及淋巴结（LN）转移有关，但在大型单机构队列研究中尚未得到充分研究。我们确定了2007年至2012年期间FIGO 1级子宫内膜样子宫内膜癌的子宫切除标本及淋巴结切除标本。回顾了电子病历和组织学切片。在464例确诊病例中，163例（35.1%）为非浸润性，60例（12.9%）有MELF，222例（47.8%）有非MELF的浸润性浸润模式成分，13例（2.8%）有纯粹的推挤性浸润边界，5例（1.1%）有纯粹的腺肌病样浸润，1例（0.2%）有纯粹的腺瘤样恶性浸润。16例有LN转移。总体而言，有MELF的病例中LN阳性的比例显著高于无MELF的病例（18.3%对1.2%，P<0.001）。比较有和无MELF的浸润性病例时，结果几乎相同（18.3%对1.8%，P<0.001）。有和无LN转移的病例每张切片中MELF腺体的最大数量无差异，P=0.137。即使在有MELF的病例中，大多数阳性LN也表现为非组织细胞样转移。只有5例（均有MELF浸润）仅表现为微转移灶或孤立肿瘤细胞。MELF病例出现阴道外复发的时间有非显著下降趋势（P=0.082，对数秩检验），由于复发率低，该分析受到限制。总之，MELF与LN转移有关，即使与其他浸润性病例相比也是如此，并且在阳性LN中显示出多种生长模式。此外，MELF病例出现阴道外复发的时间有缩短趋势。
