Hoerl H D, Hart W R
Department of Anatomic Pathology, The Cleveland Clinic Foundation, OH 44195, USA.
Am J Surg Pathol. 1998 Dec;22(12):1449-62. doi: 10.1097/00000478-199812000-00002.
Prognostic data for ovarian mucinous carcinoma are limited and difficult to interpret because of differing diagnostic criteria and inclusion of secondary tumors. To better characterize these neoplasms, 49 primary ovarian mucinous tumors diagnosed as carcinoma by the Hart and Norris criteria and staged by the FIGO system were studied. Forty-four tumors (90%) were stage I, four were stage III and one was unstaged. Sixteen tumors (33%) were classified as intraglandular ("noninvasive") carcinoma; all were stage I and all patients were alive without tumor after 4-216 months (mean, 74 months); two patients had received adjuvant chemotherapy. Stromal invasion was present in the remaining 33 cases (67%), including 19 tumors with extensive invasion and 14 with one or more discrete foci of microinvasion (each focus < or = 1 mm). The microinvasive tumors were reclassified into intraglandular carcinoma with microinvasion (nine cases) and borderline (low malignant potential) tumor with microinvasion (five cases). All microinvasive tumors were stage I and none recurred after postoperative intervals of 9-176 months (mean, 71 months) for the microinvasive carcinomas and 33-117 months (mean, 60 months) for the microinvasive borderline tumors; only 1 of the 14 patients received adjuvant chemotherapy. All 19 extensively invasive carcinomas also had intraglandular carcinoma. Fourteen were stage I, four were stage III, and one was unstaged. Eleven (79%) of the stage I patients were alive without tumor after 10-220 months (mean, 110 months), including six who received chemotherapy; one was dead without tumor and two developed progressive disease (one had received adjuvant chemotherapy). The four extensively invasive stage III carcinomas were fatal after 1-59 months. The unstaged patient received adjuvant chemotherapy and was alive without recurrence at 98 months. Conclusions of this study are as follows: (1) primary mucinous carcinomas are very uncommon tumors, after rigorous exclusion of metastatic carcinomas and tumors associated with pseudomyxoma peritonei; (2) bilaterality is not a feature of primary mucinous carcinomas; (3) FIGO stage is the single most important prognostic factor, with stage I carcinomas having a very favorable prognosis; (4) stage I carcinomas that metastasize have extensive stromal invasion; (5) extensive stromal invasion is found only in tumors with a component of intraglandular carcinoma; (6) high-stage carcinomas invariably contain extensively invasive carcinoma and have a very poor prognosis; and (7) stromal microinvasion with individual foci not exceeding 1 mm does not appear to be an adverse factor in either carcinomas or borderline tumors of stage I.
卵巢黏液性癌的预后数据有限且难以解读，这是因为诊断标准不同以及纳入了继发性肿瘤。为了更好地描述这些肿瘤，我们研究了49例根据哈特和诺里斯标准诊断为癌并按照国际妇产科联盟（FIGO）系统分期的原发性卵巢黏液性肿瘤。44例肿瘤（90%）为Ⅰ期，4例为Ⅲ期，1例未分期。16例肿瘤（33%）被归类为腺内（“非侵袭性”）癌；均为Ⅰ期，所有患者在4 - 216个月（平均74个月）后均无瘤存活；2例患者接受了辅助化疗。其余33例（67%）存在间质浸润，包括19例广泛浸润性肿瘤和14例有一个或多个离散微浸润灶（每个灶≤1mm）的肿瘤。微浸润性肿瘤被重新分类为伴有微浸润的腺内癌（9例）和伴有微浸润的交界性（低恶性潜能）肿瘤（5例）。所有微浸润性肿瘤均为Ⅰ期，微浸润性癌术后9 - 176个月（平均71个月）、微浸润性交界性肿瘤术后33 - 117个月（平均60个月）均无复发；14例患者中仅1例接受了辅助化疗。所有19例广泛浸润性癌也都有腺内癌成分。14例为Ⅰ期，4例为Ⅲ期，1例未分期。Ⅰ期患者中有11例（79%）在10 - 220个月（平均110个月）后无瘤存活，其中6例接受了化疗；1例无瘤死亡，2例病情进展（1例接受了辅助化疗）。4例广泛浸润性Ⅲ期癌在1 - 59个月后死亡。未分期的患者接受了辅助化疗，98个月时无复发存活。本研究的结论如下：（1）在严格排除转移性癌和与腹膜假黏液瘤相关的肿瘤后，原发性黏液性癌是非常罕见的肿瘤；（2）双侧性不是原发性黏液性癌的特征；（3）FIGO分期是最重要的单一预后因素，Ⅰ期癌预后非常好；（4）发生转移的Ⅰ期癌有广泛的间质浸润；（5）广泛的间质浸润仅见于有腺内癌成分的肿瘤；（6）高分期癌总是包含广泛浸润性癌，预后很差；（7）单个灶不超过1mm的间质微浸润在Ⅰ期癌或交界性肿瘤中似乎都不是不利因素。
