Arciuolo Damiano, Scaglione Giulia, Travaglino Antonio, D'Alessandris Nicoletta, Santoro Angela, Inzani Frediano, Urtueta Belen Padial, Sfregola Stefania, Raffone Antonio, Fulgione Caterina, Valente Michele, Benvenuto Roberta, Cianfrini Federica, Zannoni Gian Franco
Gynecopathology and Breast Pathology Unit, Department of Woman and Child's Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy.
Pathology Unit, Department of Medicine and Technological Innovation, University of Insubria, Varese, Italy.
Virchows Arch. 2024 Dec;485(6):989-994. doi: 10.1007/s00428-024-03818-4. Epub 2024 Jul 30.
Uteri from women undergoing chemoradiotherapy (CRT) may show reactive atypia which may mimic serous endometrial intraepithelial carcinoma (SEIC). We aimed to assess the prevalence and morphological/immunohistochemical features of post-radiotherapy serous-like endometrial changes (PoRSEC) in women undergone CRT for locally advanced cervical cancer, with a focus on the differential diagnosis with SEIC. Consecutive patients with locally advanced cervical cancer undergone CRT between 2011 and 2018 were reviewed. Endometrial histological specimens were assessed for the presence of PoRSEC. Twenty-two cases of SEIC were included for comparison. Immunohistochemistry for p53, p16, and Ki67 was performed. Out of 244 reviewed patients, 36 (14.7%) showed PoRSEC. The degree of nuclear atypia was similar between PoRSECs and SEIC. However, a papillary architecture with areas of confluent papillae was only observed in SEIC. SEIC cases showed a high mitotic activity as opposed to PoRSEC cases. The expression of p53 was aberrant in all SEICs but in none of the PoRSECs; however, 13/36 PoRSECs showed p53 positivity in most tumor cells, potentially mimicking a mutation pattern. A block-type p16 expression was observed in all SEICs and in 16/36 PoRSECs. Mean Ki67 expression was 26.9% in SEIC (range 5-70%) and 8.16% in PoRSEC (range 5-35%). While SEIC showed sharp morphological and immunohistochemical demarcation, PoRSEC were more heterogenous and merged imperceptibly with normal endometrium. In conclusion, PoRSEC may mimic SEIC both morphologically and immunohistochemically. However, a papillary architecture with cytological demarcation is typically observed in SEIC but not in PoRSEC.
接受放化疗（CRT）的女性子宫可能出现反应性异型增生，这可能会与浆液性子宫内膜上皮内癌（SEIC）相混淆。我们旨在评估因局部晚期宫颈癌接受CRT的女性放疗后浆液性子宫内膜样改变（PoRSEC）的患病率以及形态学/免疫组化特征，重点是与SEIC进行鉴别诊断。回顾了2011年至2018年间因局部晚期宫颈癌接受CRT的连续患者。评估子宫内膜组织学标本中是否存在PoRSEC。纳入22例SEIC病例进行比较。进行了p53、p16和Ki67的免疫组化检测。在244例接受评估的患者中，36例（14.7%）出现PoRSEC。PoRSEC和SEIC的核异型程度相似。然而，仅在SEIC中观察到具有融合乳头区域的乳头结构。与PoRSEC病例相反，SEIC病例显示有较高的有丝分裂活性。p53在所有SEIC中均有异常表达，但在PoRSEC中均无；然而，36例PoRSEC中有13例在大多数肿瘤细胞中显示p53阳性，可能模拟了一种突变模式。在所有SEIC和36例PoRSEC中的16例中观察到块状p16表达。SEIC中Ki67的平均表达为26.9%（范围5 - 70%），PoRSEC中为8.16%（范围5 - 35%）。虽然SEIC在形态学和免疫组化上有明显的界限，但PoRSEC更具异质性，与正常子宫内膜难以察觉地融合。总之，PoRSEC在形态学和免疫组化上可能与SEIC相似。然而，典型的具有细胞学界限的乳头结构通常见于SEIC而非PoRSEC。
