Hendrickson M, Ross J, Eifel P, Martinez A, Kempson R
Am J Surg Pathol. 1982 Mar;6(2):93-108. doi: 10.1097/00000478-198203000-00002.
A review of 256 cases of pathologic Stage I uterine adenocarcinoma treated at Stanford University Hospital revealed 26 cases of uterine papillary serous carcinoma (UPSC), a clinically aggressive and morphologically distinct variant of adenocarcinoma which closely resembles ovarian papillary serous carcinoma. These lesions are easily recognized by microscopic examination and typically feature a high degree of cytologic anaplasia and a papillary growth pattern. Invasion of the lymphatics has been a frequent finding. The relapse rate among patients with pathologic Stage I UPSC was 50% (13/26), five times the rate which would have been predicted by the incidence of UPSC. Patients with Stage I UPSC fared significantly worse than the group of nonpapillary grade II or grade III adenocarcinomas (p less than 0.0001). Forty percent of Stage I UPSC patients had deep myometrial invasion, as compared with 12% of those with all other histologic types of adenocarcinoma (p = 0.001). Women with UPSC deeply invading the myometrium tended to do worse than those with deeply invasive lesions of the more usual endometrioid type as reflected by relapse rates (after surgery alone) of 63% and 30%, respectively. Of seven Stage I corpus carcinoma patients whose initial site of failure was in the upper abdomen, six had UPSC. Thus, UPSC shares the tendency of its ovarian counterpart to spread over peritoneal surfaces. In addition to the original study group of 26 Stage I patients, 34 patients with more advanced stages of UPSC were also reviewed. Of these, 26 have been followed and four survive. Eleven of these women presented or relapsed with abdominal carcinomatosis. UPSC is a clinically aggressive neoplasm which should be distinguished from other types of primary endometrial adenocarcinoma. In cases of invasive UPSC the mode of spread, similar to that of ovarian surface epithelial carcinomas, suggests the need for adjuvant upper abdominal and pelvic irradiation or effective chemotherapy.
对斯坦福大学医院收治的256例病理I期子宫腺癌病例的回顾显示，其中有26例子宫乳头状浆液性癌（UPSC），这是一种临床侵袭性强且形态学上有别于其他腺癌的变异型，与卵巢乳头状浆液性癌极为相似。这些病变通过显微镜检查很容易识别，其典型特征是高度的细胞间变和乳头状生长模式。淋巴管浸润是常见表现。病理I期UPSC患者的复发率为50%（13/26），是根据UPSC发病率预测复发率的5倍。I期UPSC患者的预后明显比非乳头状II级或III级腺癌患者差（p<0.0001）。40%的I期UPSC患者有子宫肌层深部浸润，而其他所有组织学类型腺癌患者的这一比例为12%（p=0.001）。子宫肌层深部浸润的UPSC女性患者的预后往往比浸润子宫肌层深部的更常见的子宫内膜样型患者差，单独手术后的复发率分别为63%和30%就反映了这一点。在7例I期子宫体癌患者中，其最初的复发部位在上腹部，其中6例为UPSC。因此，UPSC与其卵巢对应物一样，有在腹膜表面扩散的倾向。除了最初的26例I期患者研究组外，还对34例更晚期的UPSC患者进行了回顾。其中，26例得到随访，4例存活。这些女性中有11例出现腹部癌转移或复发。UPSC是一种临床侵袭性肿瘤，应与其他类型的原发性子宫内膜腺癌相区分。在侵袭性UPSC病例中，其扩散方式与卵巢表面上皮癌相似，提示需要进行辅助性上腹部和盆腔放疗或有效的化疗。
