盆腔浆液性腺癌输卵管伞端的病理特征

Morphological features of the fimbria of the fallopian tube in pelvic serous adenocarcinoma

目的研究盆腔浆液性腺癌合并的输卵管伞端病变病理特点，探讨其在浆液性腺癌发生中的意义。方法观察43例盆腔浆液性腺癌（31例卵巢癌，12例腹膜癌）的输卵管伞端病理形态，对其中40例（69条输卵管）进行p53免疫组化染色。结果43例盆腔浆液性腺癌中，31例（44条输卵管）合并伞端癌，14条癌灶≤5mm，癌累及黏膜达68．3％；20例（28条输卵管）有伞端黏膜上皮内癌。44条伴有伞端癌的输卵管中，23条大体表现为伞端粘连与伞不清。伞端早期病变镜下表现为局部分泌细胞增多，上皮细胞具有一致性，黏膜皱襞走行变直，71．4％伞端上皮内癌黏膜皱襞间散落有明显异型的肿瘤性上皮蕾或单个腺体。伞端癌的053阳性表达率为86．4％，上皮内癌为60．7％。结论输卵管伞端癌是盆腔浆液性腺癌的重要组成部分，伞端上皮内癌在盆腔浆液性腺癌中十分常见，伞端是盆腔浆液性腺癌的重要起源地。

Objective To study the serous lesions of the fimbria of the fallopian tube in patients with pelvic serous adenocarcinoma and investigate its significance in the serous carcinogenesis. Methods To observe the morphological features of the fimbria of the fallopian tube in 43 cases of pelvic serous adenocarcinoma （31 cases of ovarian carcinoma and 12 cases of peritoneal carcinoma）, lmmunohistochemical examination of p53 expression was performed on samples of 69 fallopian tubes of 40 cases. Results Fimbria carcinoma was identified in 44 tubes in 31 of 43 cases. Fourteen of the carcinoma foci were ≤5 mm. In 68.3% of the fimbria carcinomas demonstrated involvement of the mucosa. Twenty eight tubes of 20 cases exhibited intraepithelial carcinoma. Twenty three of 44 tubes of the fibria carcinomas showed fimbria adherence and unclear appearance. The early histological changes of the fimbria epithelium included proliferation of local secretory cells, homogeneity, and straightening of the mucous folds. Clusters of tumor epithelial cells or single gland with atypical features floated between mucosal folds were found in 71.4% of the fimbria with intraepithelial carcinoma. 3＇he positive expression rate of p53 in the fimbria carcinomas and the fimbria intraepithelial carcinomas were 86. 4% and 60. 7%, respectively. Conclusions Fimbria carcinomas is an important component in pelvic serous adenocarcinomas. The fimbria intraepithelial carcinoma is also very common among the cases of pelvic serous adenocarcinoma. The fimbria may be an important primary site of pelvic serous adenocarcinomas.