Ambros R A, Sherman M E, Zahn C M, Bitterman P, Kurman R J
Department of Pathology, Albany Medical College, New York, NY, USA.
Hum Pathol. 1995 Nov;26(11):1260-7. doi: 10.1016/0046-8177(95)90203-1.
Endometrial intraepithelial carcinoma (EIC) is a recently described lesion characterized by replacement of endometrial surface epithelium or glands by malignant cells resembling high-grade invasive endometrial carcinoma. EIC has been identified in a high proportion of uteri containing serous carcinoma, but its association with other endometrial tumors is unknown. To determine the strength and specificity of the association of EIC with tumors displaying serous differentiation, the appearance of the endometrium in 38 uteri with serous carcinoma, 113 with endometrioid carcinoma, and 34 with malignant mixed mesodermal tumor (MMMT) were compared. EIC was present in 34 (98%) uteri with serous carcinoma compared with 7 (6%) uteri removed for endometrioid carcinoma (P = .0001). Hyperplasia without atypia was found in only 2 (5%) of 38 serous carcinomas compared with 38 (34%) of 113 endometrioid carcinomas. Similarly, atypical hyperplasia was not found in any uterus with serous carcinoma, but was present in 14 (12%) uteri with endometrioid carcinoma (P = .02). The endometrium was inactive or atrophic in 29 (76%) patients with serous carcinoma compared with 33 (29%) with endometrioid carcinoma (P = .0001). EIC was found in five (56%) of nine MMMTs with a serous epithelial component (serous-MMMT) compared with one (4%) of 25 MMMTs woth an endometrioid epithelial component (endometrioid-MMMT). As with endometrioid and serous carcinomas, hyperplasia with and without atypia was more common with endometrioid-MMMTs as compared with serous-MMMTs. Hyperplasia was found in 25 (100%) and atypical hyperplasia in 8 (32%) of 25 endometrioid-MMMTs, but in none of the nine serous-MMMTs. This study shows that EIC is frequently and specifically associated with uterine tumors displaying serous differentiation. The findings suggest that EIC represents a form of intraepithelial tumor growth characteristic of serous carcinoma and serous MMMT and that EIC is the likely precursor of these neoplasms. In addition, the findings provide further evidence supporting the view that MMMTs represent variants of carcinoma not sarcoma.
子宫内膜上皮内癌（EIC）是一种最近才被描述的病变，其特征是子宫内膜表面上皮或腺体被类似于高级别浸润性子宫内膜癌的恶性细胞所取代。在含有浆液性癌的子宫中，EIC的检出率很高，但它与其他子宫内膜肿瘤的关系尚不清楚。为了确定EIC与显示浆液性分化的肿瘤之间关联的强度和特异性，对38例患有浆液性癌、113例患有子宫内膜样癌和34例患有恶性混合性中胚叶肿瘤（MMMT）的子宫的内膜外观进行了比较。34例（98%）患有浆液性癌的子宫存在EIC，而因子宫内膜样癌切除的子宫中有7例（6%）存在EIC（P = 0.0001）。38例浆液性癌中仅有2例（5%）发现无非典型增生的增生，而113例子宫内膜样癌中有38例（34%）出现这种情况。同样，任何患有浆液性癌的子宫均未发现非典型增生，但14例（12%）患有子宫内膜样癌的子宫存在非典型增生（P = 0.02）。29例（76%）患有浆液性癌的患者子宫内膜呈静止或萎缩状态，而患有子宫内膜样癌的患者中有33例（29%）出现这种情况（P = 0.0001）。在9例具有浆液性上皮成分的MMMT（浆液性-MMMT）中有5例（56%）发现EIC，而在25例具有子宫内膜样上皮成分的MMMT（子宫内膜样-MMMT）中有1例（4%）发现EIC。与子宫内膜样癌和浆液性癌一样，与浆液性-MMMT相比，子宫内膜样-MMMT中有无非典型增生的增生更为常见。25例子宫内膜样-MMMT中有25例（100%）发现增生，8例（32%）发现非典型增生，但9例浆液性-MMMT中均未发现。本研究表明，EIC经常且特异性地与显示浆液性分化的子宫肿瘤相关。这些发现提示，EIC代表浆液性癌和浆液性MMMT特有的一种上皮内肿瘤生长形式，且EIC可能是这些肿瘤的前体。此外，这些发现为支持MMMT代表癌而非肉瘤的变体这一观点提供了进一步的证据。
