Deligdisch L, Holinka C F
Cancer Detect Prev. 1987;10(3-4):237-46.
Ninety-five patients diagnosed as having stage I endometrial carcinoma (EC) were divided into two groups, one with associated adenomatous hyperplasia (AH; group 1) and the other without (group 2). Adenomatous hyperplasia results from estrogenic stimulation of the endometrium. Therefore, patients in group 1 are considered to have an estrogen-related EC. Group 1 included 49 patients with an average age of 59; group 2 included 46 patients with an average age of 65. Review of the histologic characteristics of EC showed that group 1 tumors are better differentiated and less invasive and that their morphology is closer to the normal glandular structure of the endometrium. Group 2 tumors are less well differentiated, more often invade the myometrium, and include histologic variants such as papillary, clear cell, and anaplastic carcinoma that are dissimilar from the glandular structure of the normal endometrium. Mucinous adenocarcinomas and the presence of stromal foam cells were found to be associated with group 1 EC. Progesterone receptors (PR) were measured in a sample of 30 patients. They were present in all cases of group 1 ranging from 50 to 2,400 fmol/mg protein and absent or very low (30-190 fmol/mg protein) in group 2. All EC with stromal foam cells had high PR (380-2,400 fmol/mg protein). This study confirms that estrogen-related EC is generally a better differentiated and less aggressive tumor and suggests that there are two types of EC. The tumors not related to estrogens, which are histologically more malignant, were seen in an older age group of patients. In addition to the currently accepted methods of clinical evaluation of EC patients, defining the morphologic and biochemical characteristics of two types of EC may contribute to the management of EC, now the most prevalent cancer of the female pelvis. The patients known to be at risk for endometrial carcinoma, identifiable by abnormal hormonal manifestations (obesity, infertility, and other conditions related to hyperestrogenism) as well as those receiving exogenous estrogens are likely to develop a better differentiated and less aggressive form of neoplasia. It would be important to elaborate a system of early detection of EC in the group of elderly patients with no signs of hyperestrogenism prone to develop the less differentiated and biologically more aggressive tumors.
95例被诊断为I期子宫内膜癌（EC）的患者被分为两组，一组伴有腺瘤样增生（AH；第1组），另一组无腺瘤样增生（第2组）。腺瘤样增生是子宫内膜受雌激素刺激所致。因此，第1组患者被认为患有与雌激素相关的EC。第1组包括49例患者，平均年龄59岁；第2组包括46例患者，平均年龄65岁。对EC组织学特征的回顾显示，第1组肿瘤分化更好、侵袭性更小，其形态更接近子宫内膜的正常腺结构。第2组肿瘤分化较差，更常侵犯肌层，且包括乳头状、透明细胞和间变癌等与正常子宫内膜腺结构不同的组织学变异类型。发现黏液腺癌和基质泡沫细胞的存在与第1组EC相关。对30例患者的样本进行了孕激素受体（PR）检测。第1组所有病例均存在PR，范围为50至2400 fmol/mg蛋白，而第2组PR缺失或极低（30至190 fmol/mg蛋白）。所有伴有基质泡沫细胞的EC均有高PR（380至2400 fmol/mg蛋白）。本研究证实，与雌激素相关的EC通常是分化更好、侵袭性更小的肿瘤，并提示存在两种类型的EC。与雌激素无关的肿瘤在年龄较大的患者组中可见，其组织学上恶性程度更高。除了目前公认的EC患者临床评估方法外，明确两种类型EC的形态学和生化特征可能有助于EC的管理，EC目前是女性盆腔最常见的癌症。已知有子宫内膜癌风险的患者，可通过异常激素表现（肥胖、不孕及其他与高雌激素血症相关的情况）以及接受外源性雌激素的患者，可能会发生分化更好、侵袭性更小的肿瘤类型。在无高雌激素血症迹象、易发生分化较差且生物学上侵袭性更强肿瘤的老年患者组中，制定一套EC早期检测系统非常重要。
