Department of Pathology, Box Hill Hospital, Eastern Health, Melbourne, Vic., Australia (K.L.T.) Department of Anatomical Pathology, Pathology New South Wales, John Hunter Hospital, Hunter New England, NSW (L.F., J.S.), Australia Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK (W.G.M.).
Int J Gynecol Pathol. 2020 May;39(3):254-260. doi: 10.1097/PGP.0000000000000600.
"Atypical endosalpingiosis" (AE) is a diagnostic term used variably among pathologists to denote peritoneal lesions exhibiting architectural changes and/or cytologic atypia intermediate between endosalpingiosis and primary peritoneal serous borderline tumor (SBT). AE is a contentious entity and is not recognized in the current World Health Organisation Classification. We report a series of 10 cases classified as AE, in attempt to further characterize this lesion. The patients ranged in age from 24 to 72 yr (mean, 39.7 yr) and the commonest presenting complaint was abdominal pain. Operative findings usually comprised small peritoneal nodules and/or fibrous adhesions, predominantly involving the pelvis. The lesions were either mesothelial or submesothelial in location and typically exhibited mixed tubular and papillary architecture, sometimes with minor components of solid, cribriform or single cell growth. Epithelial multilayering was present in all cases but usually involved <25% of the lesion. There was mild nuclear atypia and mitoses were infrequent or absent. No infiltrative growth was seen. The stroma was usually inflamed and psammoma bodies were consistently present. Features which prompt a diagnosis of AE rather than endosalpingiosis include architectural alterations, usually in the form of papillae, epithelial multilayering, and mild nuclear atypia. While the extent of these findings is often less than occurs in primary peritoneal SBT or in extraovarian implants in association with an ovarian SBT, robust histologic criteria for distinction of AE from SBT do not exist. Despite this, the term AE may be of use when dealing with atypical peritoneal proliferations resembling SBT but which are limited in extent or fall just short of criteria for an unequivocal diagnosis of primary peritoneal SBT. In our series, lesions diagnosed as AE did not result in adverse clinical outcome (follow-up in 8 patients from 4 to 84 mo). Further study is required to determine whether a diagnostically reproducible and clinically relevant intermediate lesion exists between endosalpingiosis and SBT.
“非典型子宫内膜异位症”（AE）是病理学家在诊断中使用的一个术语，用于表示具有介于子宫内膜异位症和原发性腹膜浆液性交界性肿瘤（SBT）之间的结构改变和/或细胞学异型性的腹膜病变。AE 是一个有争议的实体，目前在世界卫生组织分类中没有得到认可。我们报告了一系列 10 例被归类为 AE 的病例，旨在进一步描述这种病变。患者年龄在 24 至 72 岁之间（平均 39.7 岁），最常见的主诉是腹痛。手术发现通常包括小的腹膜结节和/或纤维性粘连，主要累及骨盆。病变位于间皮或亚间皮，典型表现为混合管状和乳头状结构，有时伴有少量实性、筛状或单细胞生长。所有病例均存在上皮多层化，但通常累及病变的<25%。存在轻度核异型性，核分裂象罕见或不存在。未见浸润性生长。基质通常为炎症性，始终存在砂粒体。提示诊断为 AE 而不是子宫内膜异位症的特征包括结构改变，通常表现为乳头、上皮多层化和轻度核异型性。虽然这些发现的程度通常不如原发性腹膜 SBT 或与卵巢 SBT 相关的卵巢外植入物中那样严重，但 AE 与 SBT 之间的明确区别的组织学标准并不存在。尽管如此，当处理类似于 SBT 的但在范围上有限或仅略低于原发性腹膜 SBT 明确诊断标准的腹膜增生时，术语 AE 可能有用。在我们的系列中，诊断为 AE 的病变没有导致不良的临床结局（8 例患者的随访时间为 4 至 84 个月）。需要进一步研究以确定在子宫内膜异位症和 SBT 之间是否存在具有可重复性和临床意义的中间病变。
