Brouwer Jan, Strickland Kyle C, Ning Gang, Schmelkin Cindy B, Kolin David L, Hecht Jonathan, Nucci Marisa R, Mourits Marian J, Xian Wa, Crum Christopher P
Int J Gynecol Pathol. 2020 Mar;39(2):163-169. doi: 10.1097/PGP.0000000000000590.
Epithelial proliferations in the fallopian tube have been characterized by some as stem cell outgrowths (SCOUTs) and divided into type I and type II. Type II SCOUTs exhibit diffuse cellular beta-catenin nuclear staining (β-catenin), implying a CTNNB1 mutation. SCOUTs are more common in perimenopausal and postmenopausal women and are associated with ovarian cancer but have not been linked directly to malignancy. We analyzed type II SCOUTs in various gynecologic conditions, and searched for endometrioid atypical hyperplasias (tubal endometrioid intraepithelial neoplasia) or adenocarcinomas in the tube. β-catenin SCOUT frequency in cases of neoplasia was 66.7% per case and 30.7% per nonfimbrial cross-section for uterine endometrioid carcinomas versus 25% and 13.3% for controls, respectively (P=0.02 and 0.09). Multiple (3 or more) β-catenin SCOUTs in a single section were uncommon; 6 of 9 were associated with a carcinoma or proliferative lesion in the endometrium. Tubal endometrioid intraepithelial neoplasia/atypical hyperplasia displayed complex growth, including focal cribriform growth patterns and squamous morules. Two cases of type II SCOUTs associated with tubal endometrioid intraepithelial neoplasia/atypical hyperplasia and/or adenocarcinomas in the fallopian tube were identified, both of which coexisted with a separate endometrioid adenocarcinoma, one with bilateral ovarian endometrioid adenocarcinomas. Both benign and neoplastic tubal lesions were β-catenin. This report is the first to link components of a unique β-catenin endometrioid carcinogenic sequence in the fallopian tube. It further emphasizes the multifocal nature of endometrioid neoplasia in the female genital tract and poses questions regarding the frequency and biologic underpinnings of β-catenin proliferations in the oviduct.
输卵管上皮增生在某些情况下被描述为干细胞增生（SCOUTs），并分为I型和II型。II型SCOUTs表现为弥漫性细胞β-连环蛋白核染色（β-catenin），提示CTNNB1突变。SCOUTs在围绝经期和绝经后女性中更为常见，且与卵巢癌相关，但尚未直接与恶性肿瘤相关联。我们分析了各种妇科疾病中的II型SCOUTs，并在输卵管中寻找子宫内膜样非典型增生（输卵管子宫内膜样上皮内瘤变）或腺癌。子宫内膜样癌病例中β-连环蛋白SCOUT的频率为每例66.7%，每非伞端横截面为30.7%，而对照组分别为25%和13.3%（P = 0.02和0.09）。单个切片中多个（3个或更多）β-连环蛋白SCOUT并不常见；9例中有6例与子宫内膜中的癌或增殖性病变相关。输卵管子宫内膜样上皮内瘤变/非典型增生表现为复杂生长，包括局灶性筛状生长模式和鳞状小体。我们鉴定出2例与输卵管子宫内膜样上皮内瘤变/非典型增生和/或腺癌相关的II型SCOUTs，二者均与另一个子宫内膜样腺癌共存，其中1例伴有双侧卵巢子宫内膜样腺癌。良性和肿瘤性输卵管病变均为β-连环蛋白阳性。本报告首次将输卵管中独特的β-连环蛋白子宫内膜样致癌序列的成分联系起来。它进一步强调了女性生殖道中子宫内膜样肿瘤的多灶性，并对输卵管中β-连环蛋白增殖的频率和生物学基础提出了疑问。
