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胃型宫颈内膜腺癌卵巢转移 12 例临床病理分析

Ovarian Metastasis by Gastric-type Endocervical Adenocarcinoma: A Clinicopathologic Description of 12 Cases.

出版信息

Int J Gynecol Pathol. 2022 Jul 1;41(4):356-365. doi: 10.1097/PGP.0000000000000815. Epub 2021 Aug 4.

Abstract

Cervical gastric-type adenocarcinoma has a propensity for ovarian metastasis, but the clinicopathologic findings and possible routes of tumor spread have not been well characterized to date. To address these points, we reported 12 cervical gastric-type adenocarcinomas with ovarian metastases from a single institution. Seven patients with gastric-type adenocarcinoma had concurrent endometrial fallopian tube involvement, 5 of which showed tumors confined to the fallopian tube mucosa. Two of these 5 patients died of disease at 2 and 16 mo, and 1 recurred at 18 mo. In the remaining 5 patients, 3 had wide pelvic/peritoneal spread while the other 2 showed no evidence of uterine or tubal involvement. Among them, 1 died of disease at 94 mo, and another relapsed at 20 mo. Morphologically, ovarian tumors frequently had surface involvement consistent with metastasis, but also mimicked a primary tumor with a mixture of benign/borderline/intraepithelial carcinoma-like areas, as well as carcinoma with expansile or destructive stromal invasion. The tubal lesions were predominantly in the form of mucosal colonization without invasion of the underlying structures. Block p16 and high-risk human papillomavirus mRNA signals were not detected in cervical gastric-type adenocarcinomas and ovarian metastatic tumors. We conclude that fallopian tube spread may be associated with ovarian metastasis of cervical gastric-type adenocarcinomas that have bad clinical outcomes. Ovarian involvement may be a part of the aggressive nature of these tumors.

摘要

宫颈胃型腺癌倾向于发生卵巢转移,但迄今为止,其临床病理表现和可能的肿瘤播散途径尚未得到很好的描述。为了解决这些问题,我们报道了来自单一机构的 12 例宫颈胃型腺癌伴卵巢转移病例。7 例胃型腺癌患者同时伴有子宫内膜输卵管受累,其中 5 例肿瘤局限于输卵管黏膜。这 5 例中有 2 例患者分别在 2 个月和 16 个月时因疾病死亡,1 例在 18 个月时复发。在其余 5 例患者中,3 例有广泛的盆腔/腹膜扩散,而另外 2 例则没有子宫或输卵管受累的证据。其中,1 例患者在 94 个月时因疾病死亡,另 1 例在 20 个月时复发。在形态学上,卵巢肿瘤常表现为表面受累,符合转移,但也类似于原发性肿瘤,具有良性/交界性/上皮内癌样区域的混合,以及伴有扩张性或破坏性间质浸润的癌。输卵管病变主要表现为黏膜定植,而不侵犯下面的结构。宫颈胃型腺癌和卵巢转移性肿瘤中未检测到 p16 阻断和高危型人乳头瘤病毒 mRNA 信号。我们得出结论,输卵管播散可能与宫颈胃型腺癌的卵巢转移有关,这些转移的临床结局较差。卵巢受累可能是这些肿瘤侵袭性的一部分。

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