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原发性子宫内膜癌、宫颈癌及非妇科恶性肿瘤输卵管转移的临床病理特征:单机构经验

Clinicopathological characteristics of fallopian tube metastases from primary endometrial, cervical, and nongynecological malignancies: a single institutional experience.

作者信息

Na Kiyong, Kim Hyun-Soo

机构信息

Department of Pathology, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.

出版信息

Virchows Arch. 2017 Sep;471(3):363-373. doi: 10.1007/s00428-017-2186-z. Epub 2017 Jul 13.

Abstract

This study was aimed at investigating the clinicopathological characteristics of tubal metastases originating from primary endometrial, cervical, and nongynecological malignancies. We performed a 4-year retrospective study in which fallopian tube tissues obtained from 60 patients with tubal metastases were examined. In addition, we compared the number of tubal metastasis cases detected during periods of representative or whole tubal sampling. Twenty-three and 37 tubal metastases were found in cases examined after representative and whole tubal sampling techniques, respectively. Four cases of microscopic tubal metastases were detected via whole sampling, whereas no microscopic lesions were identified via representative sampling. The metastatic lesions originated from 14 uterine (10, endometrium; 4, cervix) and 46 nongynecological tumors (21, colon; 15, stomach; 5, biliary; 3, appendix; 2, breast). Tumors were most commonly involved in the muscle and lamina propria (n = 17). We noted distinctive histopathological features according to the extent of mural involvement: fibromyxoid stromal reaction and lymphohistiocytic infiltration in tumors involving the muscle and subepithelial connective tissue, architectural alterations of plicae in those involving the subepithelial connective tissue, and intraluminal mucinous and inflammatory exudate adjacent to intraepithelial tumors. We observed distinctive histopathological features associated with tubal metastases according to the extent of mural involvement. In addition, we demonstrated that the sampling method used in the routine microscopic examination of the fallopian tube affects the detection of tubal metastases. Our data support the notion that it is more logical to thoroughly sample both the fimbrial ends and the nonfimbriated portions of fallopian tubes for all salpingectomy specimens in the setting of cancer surgery.

摘要

本研究旨在调查源自原发性子宫内膜癌、宫颈癌和非妇科恶性肿瘤的输卵管转移瘤的临床病理特征。我们进行了一项为期4年的回顾性研究,对60例输卵管转移瘤患者的输卵管组织进行了检查。此外,我们比较了代表性取样或全输卵管取样期间检测到的输卵管转移病例数。分别在采用代表性取样技术和全输卵管取样技术检查的病例中发现了23例和37例输卵管转移瘤。通过全取样检测到4例微小输卵管转移瘤,而通过代表性取样未发现微小病变。转移瘤源自14例子宫肿瘤(10例为子宫内膜癌;4例为宫颈癌)和46例非妇科肿瘤(21例为结肠癌;15例为胃癌;5例为胆管癌;3例为阑尾癌;2例为乳腺癌)。肿瘤最常累及肌层和固有层(n = 17)。根据壁层受累程度,我们注意到了独特的组织病理学特征:累及肌层和上皮下结缔组织的肿瘤中存在纤维黏液样间质反应和淋巴组织细胞浸润,累及上皮下结缔组织的肿瘤中皱襞结构改变,以及上皮内肿瘤附近的管腔内黏液性和炎性渗出物。根据壁层受累程度,我们观察到了与输卵管转移瘤相关的独特组织病理学特征。此外,我们证明了输卵管常规显微镜检查中使用的取样方法会影响输卵管转移瘤的检测。我们的数据支持这样一种观点,即在癌症手术中,对所有输卵管切除标本的输卵管伞端和非伞端部分进行全面取样更为合理。

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