子宫浆液性乳头状癌24例临床病理分析

Uterine papillary serous carcinoma:a clinicopathological study of 24 cases

目的比较子宫浆液性乳头状癌 （ uterine papillary serous carcinoma, UPSC ） 和子宫内膜样癌 （ uterine endometrioid carcinoma, UEC）的组织病理学和免疫组化表达，以了解两种肿瘤生物学行为的差异。方法对24例UPSC和54例UEC进行组织学复查和应用免疫组化SP法检测肿瘤的p53蛋白、ER和PR的表达。结果24例UPSC占子宫内膜癌的3．77％，平均年龄UPSC组为60岁，UEC组为51．7岁（P〈0．01），晚期癌（FIGO Ⅲ-Ⅳ）UPSC组占62．5％，UEC组占35．1％（P〈0．025）。p53蛋白的表达UPSC组16例阳性（66．7％），UEC组10例阳性（18．5％），两组比较（P〈0．01）。ER阳性表达UPSC组（8．3％），UEC组（42．5％），PR阳性表达UPSC组（12．5％），UEC组（35．2％），两组比较：ER（P〈0．01），PR（P〈0．05），差异有显著性。UPSC组p53蛋白表达与肿瘤分期、分级、及肌层浸润无明显关系，而UEC组Ⅲ-Ⅳ期肿瘤的p53蛋白的表达率高于Ⅰ-Ⅱ期（P〈0．005）。UPSC的5年生存率为25％，UEC组5年生存率为80．9％（P〈0．01），两组差异有显著性。结论UPSC为p53高表达，而缺乏雌激素和孕激素受体，为高度恶性的肿瘤。它的生物学行为不同于UEC，因而强调诊断时需和其他类型的子宫内膜癌相区别。

Purpose To compare uterine papillary serous carcinoma （UPSC） and uterine endometrioid carcinoma （UEC） in histopathology and immunohistochemical expression of specific proteins for understanding the difference of biologic behaviors. Methods Twenty-four cases of UPSC and 54 cases of UEC were pathologically reviewed and analysed by SP immunohistocbemical technique for p53 protein, estrogen and progesterone receptors （ ER, PR） expression. Results 24 cases UPSC accounted for 3.77% of carcinoma of uterine endometrium. Their average age was 60 years in UPSC, and 51.7 years in UEC （ P 〈 0.01 ）. Advanced tumors （ FIGO stage Ⅲ-Ⅳ ） was observed for 62. 5% in UPSC, and 35.1% in UEC （ P 〈 0. 025 ）. Overexpression of p53 protein was detected in 16 cases （66. 7%） of UPSC, compared with 10 cases （18.5%） of UEC （P〈0.01）. Two cases （8.3%） for ER and three cases （ 12. 8% ） for PR were positive in UPSC, and 23 （42.5%） cases were ER positive, 19 （35.2%） cases were PR positive in UEC. There were significant differences between UPSC and UEC in the expression of ER （ P 〈 0. 01 ） ,and PR （ P 〈 0. 05 ）. There was no correlation between p53 overexpression and tumor stage and grade in UPSC. While for UEC the overexpression of p53 protein was found to be higher in stages Ⅲ and Ⅳ than stages Ⅰ and Ⅱ （ P 〈 0. 005 ） . Five years survival of UPSC was 25.0% , compared to 80. 9% for UEC （P 〈 0. 01 ）. The difference was statistically significant. Conclusions UPSC has p53 protein overexpression and deficiency in ER and PR with highly aggressive behaviors, which are different from UEC. Therefore, it is essential to emphasize the importance of distinguishing this lesson from other types of endometrial carcinoma.