Hernandez E, Rosenshein N B, Bhagavan B S, Parmley T H
Obstet Gynecol. 1984 Mar;63(3):330-4.
The histopathology of the original and the persistent or recurrent epithelial ovarian cancer in 34 patients was simultaneously reviewed by two pathologists. The time between removal of the primary tumor and removal of the persistent or recurrent tumor ranged from four to 132 months (median, 13 months; mean, 25 months). The initial operation was followed by multiagent chemotherapy in 23 patients, single-agent chemotherapy in seven, radiation and chemotherapy in two, radiation in one, and no therapy in one patient. In four of the 34 primary tumors, a mixed tumor composition was initially identified. In comparing the initial histopathology with that of persistent or recurrent tumors, a change was identified in nine patients. In four patients, the tumor changed from a mixed to an undifferentiated histologic type; in four patients there was a change from a lower to a higher tumor grade, and two of these patients also had a change in tumor cell type from serous to undifferentiated. In the ninth patient, the tumor changed from a large cell undifferentiated to a small cell undifferentiated carcinoma. The observed changes could be the result of 1) modification of the tumor by cytotoxic therapy, 2) spontaneous dedifferentiation of the initial tumor, 3) tumor cell heterogeneity with preferential growth of one cell type over the others, or 4) the development of a second primary tumor.
两位病理学家同时回顾了34例原发性及持续性或复发性上皮性卵巢癌的组织病理学情况。原发性肿瘤切除与持续性或复发性肿瘤切除之间的时间间隔为4至132个月（中位数为13个月；平均数为25个月）。23例患者在初次手术后接受了多药化疗，7例接受了单药化疗，2例接受了放疗及化疗，1例接受了放疗，1例未接受任何治疗。在34例原发性肿瘤中，有4例最初被确定为混合性肿瘤成分。在比较原发性肿瘤与持续性或复发性肿瘤的组织病理学情况时，发现9例患者有变化。4例患者的肿瘤从混合性组织学类型转变为未分化型；4例患者的肿瘤分级从低级别变为高级别，其中2例患者的肿瘤细胞类型也从浆液性转变为未分化型。在第9例患者中，肿瘤从大细胞未分化癌转变为小细胞未分化癌。观察到的这些变化可能是以下原因导致的：1）细胞毒性疗法对肿瘤的改变；2）初始肿瘤的自发去分化；3）肿瘤细胞异质性，其中一种细胞类型比其他细胞类型优先生长；4）第二原发性肿瘤的发生。
