卵巢浆黏液性癌的临床病理分析

Clinicopathological study of ovarian seromucinous carcinomas

目的 探讨卵巢浆黏液性癌（ovarian seromucinous carcinomas,OSMCs）的临床病理特征、免疫表型、预后特点,以及与卵巢胃肠型黏液性癌（ovarian gastrointestinal mucinous carcinomas,OGIMCs）的差异。方法 采用免疫组化EliVision法检测所有癌组织中CK7、CK20、CDX2、WT1、p53、ER、PR、和ARID1A的表达,分析比较15例OSMCs和33例OGIMCs的临床病理特点和预后。结果 OSMCs组平均年龄与OGIMCs组相比差异无显著性（P〉0.05）;按FIGO分期,OSMCs中Ⅱ~Ⅳ期所占的比例明显高于OGIMCs组（P〈0.05）;OSMCs患者中位生存时间明显低于OGIMCs组（P〈0.05）;两组间5年生存率差异无统计学意义（P〉0.05）。OSMCs组中子宫内膜异位症比例高于OGIMCs组（P〈0.05）;OSMCs比OGIMCs更多见双侧卵巢累犯（P〈0.05）;OSMCs平均肿瘤直径小于OGIMCs组（P〈0.05）。OSMCs组织学形态和细胞学形态复杂多样,但均可见典型的子宫颈管型黏液上皮癌和低级别浆液性癌区域;以乳头状结构为主,还可见腺样、微小腺样分化,实性生长;部分病例见子宫内膜样癌分化。OSMCs比OGIMCs更多见破坏性浸润。OSMCs均表达CK7,不表达CDX2,ER（80.0%）和PR（66.7%）阳性率均高于OGIMCs组（P〈0.05）,而ARID1A阳性率（40.0%）低于OGIMCs组（P〈0.05）。结论 OSMCs比OGIMCs组织细胞学形态更复杂多样,以浸润性破坏为主,OSMCs可能与子宫内膜异位症密切相关。OSMCs与OGIMCs的组织细胞起源可能不同。OSMCs中ARID1A失活可能与ER和PR表达上调有关。OSMCs是一种比OGIMCs恶性程度更高、预后更差的肿瘤。

Purpose To study the clinicopathological features, immunohistochemical characteristics and prognosis of ovarian seromucinous carcinomas （OSMCs）, and to compare the differences between OSMCs and ovarian gastrointestinal mucinous carcinomas （OGIMCs）. Methods A total of 15 cases of OSMCs and 33 cases of OGIMCs were selected for analysis and comparison of clinicopathological feature and prognosis. Immunohistochemistry EliVision method was used to detect CK7, CK20, CDX2, WT1, p53, ER, PR, and ARID1A in all cases. Results There was no significant difference of median age between of OSMCs and OGIMCs （P 〉 0. 05 ）. The median survival time of OSMCs was lower than that of OGIMCs （ P 〈 0. 05 ）. There was no significant difference of 5-year survival rates between the two groups （ P 〉 0. 05 ）. The endometriosis in OSMCs was obviously higher than that in GIMCs group （ P 〈 0. 05 ）. The bilateral ovaries involvement was more often seen in OSMCs compared to OGIMCs （ P 〈 0. 05 ）. The average diameter of tumor in OSMCs was significantly greater than that in OGIMCs （P 〈 0. 05）. The majority of OSMCs exhibited a predominant papillary architecture with lesser components of glandular, microglandular, and solid growth, there was endometrioid differentiation in some cases. CK7 was positive and CDX2 was negative in all cases of OSMCs. The expression of ER （80. 0% ） and PR （66. 7% ） in OSMCs were significantly higher than that in OGIMCs （ P 〈 0.05 ）. The expression of ARID1A expression （40. 0% ） was lower than that in OGIMCs （P 〈 0. 05 ）. Conclusions Comparing with OGIMCs, There was more complex histological morphology in OSMCs with the predominant pattern of destructive infiltration. OSMCs may be closely associated with endometriosis, and the tumour origin of OSMCs and OGIMCs may be different. ARID1A inactivation may be closely related to ER and PR upregnlation in OSMCs. OSMCs was a more malignant and worse prognostic tumor than OGIMCs.