Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada.
Department of Pathology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
Am J Surg Pathol. 2018 Apr;42(4):534-544. doi: 10.1097/PAS.0000000000001016.
Although infrequently encountered, the diagnosis of ovarian high-grade endometrioid carcinoma remains a diagnostic challenge with potential consequences for targeted therapies and genetic counselling. We studied the clinical, morphologic, and immunohistochemical features of ovarian high-grade endometrioid carcinomas and their diagnostic reproducibility compared with tuboovarian high-grade serous carcinomas. Thirty cases confirmed as International Federation of Gynecology and Obstetrics grade 3 endometrioid carcinomas were identified from 182 ovarian endometrioid carcinomas diagnosed in Alberta, Canada, between 1978 and 2010, from the population-based Alberta Ovarian Tumor Types cohort. Cases of lower grade endometrioid and high-grade serous carcinoma served for comparison. Ten immunohistochemical markers were assessed on tissue microarrays. Clinical data were abstracted and survival analyses performed using Cox regression. Interobserver reproducibility for histologic type was assessed using 1 representative hematoxylin and eosin-stained slide from 25 randomly selected grade 3 endometrioid carcinomas and 25 high-grade serous carcinomas. Histotype was independently assigned by 5 pathologists initially blinded to immunohistochemical WT1/p53 status, with subsequent reassessment unblinded to WT1/p53 status. Patients diagnosed with grade 3 endometrioid carcinoma had a significantly longer survival compared with high-grade serous carcinoma in univariate analysis (hazard ratio [HR]=0.34, 95% confidence interval [CI]=0.16-0.67, P=0.0012) but not after adjusting for age, stage, treatment center, and residual tumor (HR=1.01, 95% CI=0.43-2.16, P=0.98). Grade 3 endometrioid carcinoma cases (N=30) were identical to grade 2 endometrioid carcinoma cases (N=23) with respect to survival in univariate analysis (HR=1.07, 95% CI=0.39-3.21, P=0.89) and immunohistochemical profile. Using histomorphology alone, interobserver agreement for the diagnosis of grade 3 endometrioid or high-grade serous carcinoma was 69%, which significantly increased (P<0.0001) to 96% agreement with the knowledge of WT1/p53 status. Our data support the diagnostic value of WT1/p53 status in differentiating between grade 3 endometrioid carcinoma and high-grade serous carcinoma. However, grade 3 and grade 2 endometrioid carcinomas showed no differences in immunophenotype or clinical parameters, suggesting that they could be combined into a single group.
虽然很少见，但卵巢高级别子宫内膜样癌的诊断仍然是一个具有挑战性的诊断，可能会对靶向治疗和遗传咨询产生影响。我们研究了卵巢高级别子宫内膜样癌的临床、形态学和免疫组织化学特征，并将其与管状卵巢高级别浆液性癌进行了比较。从加拿大艾伯塔省 1978 年至 2010 年间基于人群的艾伯塔省卵巢肿瘤类型队列中诊断的 182 例卵巢子宫内膜样癌中，确定了 30 例经国际妇产科联合会（FIGO）确认为 3 级的子宫内膜样癌。低级别子宫内膜样癌和高级别浆液性癌的病例用于比较。在组织微阵列上评估了 10 种免疫组织化学标志物。使用 Cox 回归分析提取临床数据并进行生存分析。使用 25 例随机选择的 3 级子宫内膜样癌和 25 例高级别浆液性癌的 1 张代表性苏木精和伊红染色幻灯片评估组织学类型的观察者间重现性。5 位病理学家最初对免疫组织化学 WT1/p53 状态进行盲法评估，然后对 WT1/p53 状态进行非盲法评估。独立分配组织学类型，然后对 5 位病理学家进行了盲法评估，然后对 WT1/p53 状态进行了非盲法评估。组织学类型。在单变量分析中，与高级别浆液性癌相比，诊断为高级别子宫内膜样癌的患者具有显著更长的生存时间（风险比[HR]=0.34，95%置信区间[CI]=0.16-0.67，P=0.0012），但在校正年龄、分期、治疗中心和残留肿瘤后没有（HR=1.01，95%CI=0.43-2.16，P=0.98）。在单变量分析中，3 级子宫内膜样癌病例（N=30）与 2 级子宫内膜样癌病例（N=23）的生存情况相同（HR=1.07，95%CI=0.39-3.21，P=0.89）和免疫组织化学特征。仅使用组织形态学，观察者对 3 级子宫内膜样癌或高级别浆液性癌的诊断的一致性为 69%，当知道 WT1/p53 状态时，一致性显著增加（P<0.0001）至 96%。我们的数据支持 WT1/p53 状态在区分 3 级子宫内膜样癌和高级别浆液性癌中的诊断价值。然而，3 级和 2 级子宫内膜样癌在免疫表型或临床参数上没有差异，表明它们可以组合成一个单一的组。
