Zhao R J, Wang Y Y, Li Z, Wu K Y, Kong L F, Zheng W X
Department of Pathology, Henan Provincial People's Hospital, Zhengzhou 450003, China.
Department of Obstetrics and Gynecology, Henan Provincial People's Hospital, Zhengzhou 450003, China.
Zhonghua Bing Li Xue Za Zhi. 2017 Aug 8;46(8):542-547. doi: 10.3760/cma.j.issn.0529-5807.2017.08.005.
To study the pathologic features of fallopian tubal epithelium in patients with pelvic high-grade serous carcinoma (HGSC), to investigate its role in pelvic serous carcinogenesis and to reclassify the primary site of HGSC based on recently proposed criteria. The fallopian tubes in 58 cases of pelvic HGSC (54 cases of ovarian primary, 3 cases of tubal primary, 1 case of peritoneum) and 25 cases of pelvic non-HGSC (5 cases of ovarian low-grade serous cancer, 9 cases of endometrioid cancer, and 11 cases of clear cell ovary carcinoma) were collected from June 2015 to December 2016, and serially examined under light microscope (SEE-FIM protocol). Immunostaining for p53 and Ki-67 was performed to evaluate the presence of p53 signature, serous tubal intraepithelial lesion (STIL), serous tubal intraepithelial carcinoma (STIC) and invasive carcinoma in these fallopian tubes. Meanwhile, primary site of HGSC based on the recently proposed diagnostic criteria were also reclassified. Among the study group, the frequencies of p53 signature, STIL, STIC and invasive HGSC were 27.6% (16/58), 43.1% (25/58), 36.2% (21/58) and 67.2% (39/58), respectively, while in control group, the proportions were 24.0% (6/25), 0, 0 and 8.0% (2/25), respectively. The continuum of epithelial changes in the process of serous neoplasia including p53 signature, STIL, STIC and invasive carcinoma was identified in 8 cases of pelvic HGSC. The proportions of STIL, STIC and invasive carcinomas in HGSC group were higher than that in non-HGSC group (<0.01). About 80.0% (20/25) of STIL and 85.7% (18/21) of STIC were present unilaterally. Diagnostically, the study group contained the 17 cases of ovarian HGSC, 40 cases of tubal HGSC, and 1 case of peritoneal HGSC after reclassification of the cancer primary. Continuous changes of tubal epithelium including p53 signature, STIL, STIC and invasive carcinomas are identified in patients with HGSC, supporting the current understanding that the fallopian tube is likely the cellular source of the majority HGSC. STIL and STIC may be specific to pelvic HGSC and may act as a target for future research on the early detection and prevention of this disease. The newly proposed diagnostic criteria for pelvic HGSC will lead us to more accurate classification of cancer primary sites. Correct classification of HGSC may have potential impacts for cancer prevention and improve our understanding of ovarian serous carcinogenesis.
研究盆腔高级别浆液性癌（HGSC）患者输卵管上皮的病理特征，探讨其在盆腔浆液性癌发生中的作用，并根据最近提出的标准对HGSC的原发部位进行重新分类。收集2015年6月至2016年12月期间58例盆腔HGSC患者（54例卵巢原发，3例输卵管原发，1例腹膜原发）和25例盆腔非HGSC患者（5例卵巢低级别浆液性癌，9例子宫内膜样癌，11例透明细胞卵巢癌）的输卵管，按照连续上皮内病变显微镜检查法（SEE-FIM方案）进行连续切片显微镜检查。对p53和Ki-67进行免疫染色，以评估这些输卵管中p53特征、浆液性输卵管上皮内病变（STIL）、浆液性输卵管上皮内癌（STIC）和浸润性癌的存在情况。同时，根据最近提出的诊断标准对HGSC的原发部位进行重新分类。研究组中，p53特征、STIL、STIC和浸润性HGSC的发生率分别为27.6%（16/58）、43.1%（25/58）、36.2%（21/58）和67.2%（39/58），而对照组中的比例分别为24.0%（6/25）、0、0和8.0%（2/25）。在8例盆腔HGSC中发现了浆液性肿瘤形成过程中包括p53特征、STIL、STIC和浸润性癌在内的上皮连续变化。HGSC组中STIL、STIC和浸润性癌的比例高于非HGSC组（<0.01）。约80.0%（20/25）的STIL和85.7%（18/21）的STIC单侧存在。在对癌症原发灶进行重新分类后，研究组诊断为17例卵巢HGSC、40例输卵管HGSC和1例腹膜HGSC。在HGSC患者中发现了输卵管上皮的连续变化，包括p53特征、STIL、STIC和浸润性癌，支持了目前认为输卵管可能是大多数HGSC细胞来源的观点。STIL和STIC可能是盆腔HGSC所特有的，可能成为未来该疾病早期检测和预防研究的靶点。新提出的盆腔HGSC诊断标准将使我们对癌症原发部位进行更准确的分类。HGSC的正确分类可能对癌症预防有潜在影响，并增进我们对卵巢浆液性癌发生的理解。
