Hanley Krisztina Z, Birdsong George G, Mosunjac Marina B
From the Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia (Dr Hanley); and the Department of Pathology and Laboratory Medicine, Grady Memorial Hospital, Atlanta, Georgia (Drs Birdsong and Mosunjac).
Arch Pathol Lab Med. 2017 Apr;141(4):528-541. doi: 10.5858/arpa.2016-0284-SA. Epub 2017 Feb 28.
There have been several updates recently on the classification of uterine tumors. Endometrial carcinomas have traditionally been divided into 2 types, but some are difficult to classify and do not fit readily into either of the currently recognized categories. The Cancer Genome Atlas Research Network has recently defined 4 new categories of endometrial cancer on the basis of mutational spectra, copy number alteration, and microsatellite instability, which might provide independent prognostic information beyond established risk factors. The Society of Gynecologic Oncology, moreover, now recommends systematic screening of every patient with endometrial cancer for Lynch syndrome. The new definition of high-grade endometrial stromal sarcoma disregards the number of mitotic figures as a primary diagnostic criterion and instead specifies moderate atypia still resembling stromal origin but lacking the pleomorphism of undifferentiated uterine sarcoma; these tumors also harbor a JAZF1-SUZ12 gene rearrangement. Mitotic count, atypia, and coagulative necrosis are the main histologic criteria that define leiomyosarcoma. Determining the type of necrosis can be very challenging in patients receiving various treatment modalities for symptomatic fibroids before myomectomy, since key histologic features of ischemic-type necrosis are often absent. Ancillary stains including p16, p53, MIB-1, trichrome, and reticulin may be helpful in tumors harboring necrosis that is difficult to classify. Minimally invasive gynecologic surgeries have introduced histologic artifacts that complicate the diagnosis. It is essential to recognize these as procedure-related artifacts to avoid upstaging tumors and triggering unnecessary adjuvant treatment.
最近子宫肿瘤的分类有了一些更新。子宫内膜癌传统上分为2种类型，但有些难以分类，不易归入目前认可的任何一类。癌症基因组图谱研究网络最近根据突变谱、拷贝数改变和微卫星不稳定性定义了4种新的子宫内膜癌类别，这可能提供超出既定风险因素的独立预后信息。此外，妇科肿瘤学会现在建议对每例子宫内膜癌患者进行林奇综合征的系统筛查。高级别子宫内膜间质肉瘤的新定义不再将有丝分裂象的数量作为主要诊断标准，而是明确为中度异型性，仍类似间质来源，但缺乏未分化子宫肉瘤的多形性；这些肿瘤还存在JAZF1-SUZ12基因重排。有丝分裂计数、异型性和凝固性坏死是定义平滑肌肉瘤的主要组织学标准。对于在肌瘤切除术前因有症状的肌瘤接受各种治疗方式的患者，确定坏死类型可能非常具有挑战性，因为缺血型坏死的关键组织学特征往往不存在。包括p16、p53、MIB-1、三色染色和网状纤维染色在内的辅助染色可能有助于诊断难以分类的坏死性肿瘤。微创妇科手术引入了组织学假象，使诊断复杂化。必须将这些识别为与手术相关的假象，以避免肿瘤分期过高并引发不必要的辅助治疗。
