Hatano Yuichiro, Tamada Maho, Asano Nami, Hayasaki Yoh, Tomita Hiroyuki, Morishige Ken-Ichirou, Hara Akira
Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu, 501-1194, Japan.
Department of Obstetrics and Gynecology, Gifu University Graduate School of Medicine, Gifu, 501-1194, Japan.
Diagn Pathol. 2019 Jan 12;14(1):4. doi: 10.1186/s13000-019-0781-9.
High-grade serous carcinoma, a representative high-grade ovarian carcinoma, is believed to be closely associated with a TP53 mutation. Recently, this category of ovarian carcinoma has gained increasing attention owing to the recognition of morphological varieties of TP53-mutated high-grade ovarian carcinoma. Herein, we report the case of a patient with high-grade serous carcinoma with mucinous differentiation.
A 59-year-old postmenopausal woman was referred to the gynecologist because of abnormal vaginal bleeding. The radiological assessment revealed an intrapelvic multicystic mass, which was interpreted as an early right ovarian cancer and then removed by radical surgery. Histologically, the cancer cells were found in the bilateral ovaries and para-aortic lymph nodes. The cancer cells showed high-grade nuclear atypia and various morphologies, including the solid, pseudo-endometrioid, transitional cell-like (SET) pattern, and mucin-producing patterns. Benign and/or borderline mucin-producing epithelium, serous tubal intraepithelial carcinoma, and endometriosis-related lesions were not observed. In immunohistochemistry analyses, the cancer cells were diffuse positive for p53; block positive for p16; partial positive for WT1, ER, PgR, CDX2 and PAX8; and negative for p40, p63, GATA3, Napsin A, and vimentin. The Ki-67 labeling index of the cancer cells was 60-80%. Direct sequencing revealed that the cancer cells contained a missense mutation (c.730G>A) in the TP53 gene.
Mucinous differentiation in high-grade serous carcinoma is a rare and unique ovarian tumor phenotype and it mimics the phenotypes of mucinous or seromucinous carcinoma. To avoid the misdiagnosis, extensive histological and immunohistochemical analyses should be performed when pathologists encounter high-grade mucin-producing ovarian carcinoma. The present case shows that the unusual histological characteristic of high-grade serous carcinoma, the "SET" feature, could be extended to the solid, transitional, endometrioid and mucinous-like (STEM) feature.
高级别浆液性癌是一种典型的高级别卵巢癌，被认为与TP53突变密切相关。近年来，由于认识到TP53突变的高级别卵巢癌的形态学多样性，这类卵巢癌越来越受到关注。在此，我们报告一例具有黏液样分化的高级别浆液性癌患者的病例。
一名59岁的绝经后女性因异常阴道出血转诊至妇科医生处。影像学评估显示盆腔内多囊性肿块，被诊断为早期右侧卵巢癌，随后行根治性手术切除。组织学检查发现癌细胞存在于双侧卵巢和主动脉旁淋巴结。癌细胞表现出高级别核异型性和多种形态，包括实性、假子宫内膜样、移行细胞样（SET）模式和黏液产生模式。未观察到良性和/或交界性黏液产生上皮、浆液性输卵管上皮内癌和子宫内膜异位症相关病变。免疫组织化学分析显示，癌细胞p53弥漫阳性；p16块状阳性；WT1、ER、PgR、CDX2和PAX8部分阳性；p40、p63、GATA3、Napsin A和波形蛋白阴性。癌细胞的Ki-67标记指数为60-80%。直接测序显示癌细胞的TP53基因存在错义突变（c.730G>A）。
高级别浆液性癌中的黏液样分化是一种罕见且独特的卵巢肿瘤表型，它模仿黏液性或浆液黏液性癌的表型。为避免误诊，病理学家在遇到高级别黏液产生性卵巢癌时应进行广泛的组织学和免疫组织化学分析。本病例表明，高级别浆液性癌不寻常的组织学特征，即“SET”特征，可能扩展为实性、移行性、子宫内膜样和黏液样（STEM）特征。
