Hospital Universitari Arnau de Vilanova, IRBLLEIDA, Lleida, Spain.
Pathobiology. 2018;85(1-2):35-40. doi: 10.1159/000475529. Epub 2017 Jun 15.
Endometrial carcinoma (EC) shows intertumor heterogeneity, with several different histologic types differing in their morphologic and molecular features. There is also intratumoral morphologic heterogeneity, with different neoplastic cell components within the same tumor, with different morphologic and molecular features. In this article, we discuss the consequences of tumor heterogeneity in EC at the morphologic and molecular levels, by describing some illustrative examples produced by the research team. They are (1) morphologic heterogeneity in conventional EC and mixed tumors, (2) EC with microsatellite instability, (3) branched evolution as shown by exome sequencing analysis, (4) morphologic, molecular, and metabolomic differences between the tumor surface and myometrial invasion front, (5) tumor heterogeneity at the microenviromental level, (6) the sensitivity of endometrial aspirates to detect tumor heterogeneity in EC, and (7) sampling strategies to detect tumor heterogeneity in hysterectomy specimens. Tumor heterogeneity may have an important clinical impact, since it can be challenging to identify minor tumor cell populations that may have an impact on diagnosis, prognosis, and therapeutic decisions for patients with EC.
子宫内膜癌（EC）表现出肿瘤间异质性，几种不同的组织学类型在形态和分子特征上存在差异。肿瘤内也存在形态异质性，同一肿瘤内存在不同的肿瘤细胞成分，具有不同的形态和分子特征。本文通过描述研究团队提供的一些示例，讨论了 EC 在形态和分子水平上肿瘤异质性的后果。它们是：（1）常规 EC 和混合性肿瘤的形态异质性；（2）微卫星不稳定的 EC；（3）外显子组测序分析显示的分支进化；（4）肿瘤表面与子宫肌层浸润前缘之间的形态、分子和代谢组学差异；（5）微环境水平的肿瘤异质性；（6）子宫内膜抽吸物检测 EC 肿瘤异质性的敏感性；以及（7）检测子宫切除术标本中肿瘤异质性的采样策略。肿瘤异质性可能具有重要的临床影响，因为识别可能对诊断、预后和 EC 患者治疗决策产生影响的少量肿瘤细胞群具有挑战性。
