Ambros R A, Ballouk F, Malfetano J H, Ross J S
Department of Pathology, Albany Medical College, NY 12208.
Am J Surg Pathol. 1994 Jun;18(6):569-75.
The frequency, topography, and significance of papillary (villoglandular) differentiation were examined in 142 cases of endometrioid (typical) carcinoma of the endometrium. Forty-four (31%) of the 142 cases showed papillary differentiation, including eight carcinomas limited to the endometrium and 36 cases with myometrial invasion. In 24 (67%) of the 36 cases with myometrial invasion, papillary differentiation was found in both the endometrial component of the carcinoma and in tumor invading the myometrium. In the remaining 12 cases, papillary differentiation was found in the endometrial component but not in tumor invading the myometrium, which showed either glandular or solid growth patterns. When patients were divided into two groups based on the presence or absence of papillary differentiation, regardless of its location, the two groups did not differ in prognosis or frequency of pathologic changes associated with outcome. In the subgroup of patients with tumors showing myometrial invasion, however, endometrioid carcinomas displaying papillary differentiation in the myometrium were associated with a higher frequency of vascular invasion (p = 0.007), a higher rate of lymph node metastasis (p = 0.001), and worse outcome (p = 0.05) compared with carcinomas showing myometrial invasion in the form of glandular or solid patterns regardless of the presence or absence of papillary differentiation in the endometrium. The results of the present study suggest that papillary differentiation is of significance in endometrioid carcinoma. If these findings can be confirmed, a separate designation for these tumors as "papillary endometrioid carcinomas" or "villoglandular endometrial carcinomas" would be helpful if use of these terms was limited to endometrioid carcinomas manifesting papillary differentiation in the myometrium.
对142例子宫内膜样（典型）子宫内膜癌病例的乳头（绒毛腺）分化的频率、形态及意义进行了研究。142例病例中有44例（31%）显示乳头分化，其中8例癌局限于子宫内膜，36例有肌层浸润。在36例有肌层浸润的病例中，24例（67%）在癌的子宫内膜成分及浸润肌层的肿瘤中均发现乳头分化。其余12例中，仅在子宫内膜成分中发现乳头分化，而浸润肌层的肿瘤呈腺性或实性生长模式。当根据有无乳头分化将患者分为两组时，无论其位置如何，两组在预后或与结局相关的病理改变频率方面并无差异。然而，在肿瘤有肌层浸润的患者亚组中，与呈腺性或实性模式浸润肌层的癌相比，无论子宫内膜有无乳头分化，肌层中显示乳头分化的子宫内膜样癌血管浸润频率更高（p = 0.007），淋巴结转移率更高（p = 0.001），结局更差（p = 0.05）。本研究结果提示乳头分化在子宫内膜样癌中具有重要意义。如果这些发现能够得到证实，将这些肿瘤单独命名为“乳头型子宫内膜癌”或“绒毛腺型子宫内膜癌”可能会有所帮助，前提是这些术语仅用于在肌层中表现出乳头分化的子宫内膜样癌。
