子宫内膜浆液性癌患者输卵管伞端组织的病理特征研究

Pathologic features of fallopian tubal fimbriae in patients with endometrial serous carcinoma

目的 通过研究子宫内膜浆液性癌（ESC）患者输卵管伞端组织的病理特征,初步探讨ESC的发生与输卵管伞端组织病变的关系.方法 收集北京大学人民医院1999年至2013年间收治的所有典型ESC患者共30例（包括Ⅰ期13例,Ⅱ期2例,Ⅲ期15例）,取其石蜡包埋的典型ESC组织、双侧输卵管伞端组织.（1）通过HE染色切片观察ESC患者的输卵管伞端组织的病理特征,分析输卵管伞端上皮内病变特点、程度及其与ESC期别的关系.（2）利用免疫组化法检测ESC患者的内膜癌组织与其输卵管伞端组织中p53、人类表皮生长因子2（HER2/neu）、高迁移率族蛋白A2（HMGA2）、膜联蛋白Ⅳ（ANX-Ⅳ）蛋白的表达,并分析其相关性.结果 （1）30例ESC患者中,15例（50%）合并输卵管伞端上皮的病变,包括输卵管浆液性癌9例（Ⅲa期5例,Ⅲc期4例）,输卵管上皮内癌（STIC）2例（Ⅰa期、Ⅰb期各1例）,输卵管上皮增生2例（Ⅰa期）,输卵管浆液性癌合并STIC 1例（Ⅲa期）,输卵管浆液性癌合并输卵管上皮增生1例（Ⅲc期）.（2）ESC患者的内膜癌组织中p53蛋白的阳性表达率为87%（26/30）,其输卵管伞端组织中为30%（9/30）,两者比较,差异有统计学意义（P=0.001）.ESC患者的内膜癌组织与其输卵管伞端组织中p53蛋白的表达呈中度正相关（r=0.506,P=0.022）.（3）ESC患者的内膜癌组织中ANX-Ⅳ蛋白的阳性表达率为83%（25/30）,其输卵管伞端组织中为20%（6/30）;内膜癌组织中HER2/neu蛋白的阳性表达率为70%（21/30）,其输卵管伞端组织中为23%（7/30）;内膜癌组织中HMGA2蛋白的阳性表达率为83%（25/30）,其输卵管伞端组织中为20%（6/30）.上述3个蛋白在内膜癌组织与其输卵管组织中分别比较,差异均有统计学意义（P〈0.05）;但上述3个蛋白在ESC患者的内膜癌组织与其输卵管伞端组织中的表达均无相关性（P〉0.05）.结论 Ⅰ期ESC患者的输卵管伞端合并STIC,提示STIC与ESC的发生可能存在一定的关系;在内膜癌与其输卵管组织中,p53蛋白的表达存在相关性,而HER2/neu、ANX-Ⅳ、HMGA2的表达无相关性.

Objective To discuss the potential relationship between endometrial serous carcinoma （ESC） and tubal epithelial lesions by pathologic examination of fallopian tubes with ESC. Methods A total of 30 cases of typical ESC were reexamined and chosen by the pathologist. In each case, bilateral fallopian tubes were submitted to examination of pathologic morphology and immunostaining for p53, annexin Ⅳ（ANX-Ⅳ）, human epidermal growth factor receptor 2（HER2）/neu, and high-mobility group protein A2 （HMGA2）. Results Fallopian tubal epithelial lesions were found in 15 cases, including 9 cases tubal serous carcinoma, 2 cases serous tubal intraepithelial carcinoma （STIC） and 2 cases epithelial hyperplasia. Both sides of tubal serous carcinoma and STIC were found in 1 case. The results showed the positive expression for p53 in 26（87%）out of 30 endometrial malignant specimens tissues and 9（30%）tubal tissues samples （P〉0.05）. Twenty-five（83%）endometrial malignant specimens tissues and 6（20%）tubal tissues samples showed the positive expression of ANX-Ⅳ. Twenty-one（70%）endometrial malignant tissues and 7（23%） tubal tissues showed the positive expression of HER2/neu. Twenty-five（83%） endometrial malignant tissues and 6（20%）tubal tissues showed the positive expression of HMGA2. While, there were significant differences among the expression of three proteins between endometrium and the fallopian tube site （all P〈0.05）. Conclusions STIC may be associated with the occurrence of ESC. The expression of p53 was positively correlated between the fallopian tube and the endometrium. ANX-Ⅳ,HER2/neu and HMGA2 were extensively expressed in ESC.