子宫外盆腔浆液性癌的起源

The Origin of Non-uterine Pelvic Serous Carcinomas

子宫外盆腔浆液性癌包括卵巢浆液性癌、输卵管浆液性癌、腹膜浆液性癌。根据细胞分化程度可将卵巢浆液性癌分为低级别和高级别浆液性癌,两者临床特征、预后及分子特征完全不同,是两种不同的疾病。大量证据表明前者由卵巢的良性囊肿如浆液性囊腺瘤、内膜样囊肿等经交界性肿瘤逐步发展而来,而后者起源不明确。传统观点认为高级别浆液性癌起源于卵巢上皮,但对因携带遗传性乳腺癌-卵巢癌综合征易感基因(BRCA)突变行预防性输卵管卵巢切除术的患者手术标本行病理检查,可发现其输卵管伞端存在上皮内癌灶,可能为卵巢高级别浆液性癌的前驱病灶。输卵管浆液性癌及腹膜浆液性癌患者的临床及分子特征与卵巢高级别浆液性癌相似,且输卵管伞端也可见上皮内癌灶,故卵巢高级别浆液性癌、输卵管浆液性癌、腹膜浆液性癌可能均起源于输卵管伞端的上皮内癌灶。

Serous ovarian carcinoma, serous tubal carcinoma and serous peritoneal carcinoma comprise non-uterine pelvic serous carcinoma. Serous ovarian carcinoma can be divided into low-grade and high-grade subtypes according to cell differentiation. These two subtypes are distinct disease for the extreme variation in clinical manifestation, prognosis and endometrial cysts molecular feature. It was considered that low-grade subtype arises from benign cysts of ovarian like the serous cystadenomas and endometrial cysts by borderline tumors. The origin of high-grade subtype is unclear and believed to arise from ovarian surface epithelium traditionally. Pathological examination of the fallopian tube after risk-reducing salpingo-oophorectomy of BRCA mutation carriers found that serous tubal intraepithelial carcinoma （STIC） was usually present,which may be the precursor lesion for high-grade serous ovarian carcinoma. The same lesion was found at the fimbriae of patients diagnosed of serous tubal or peritoneal carcinoma which sharing the similar clinical and molecular characters to high-grade serous ovarian carcinoma. It was suggested that the above three types of non-uterine serous carcinoma may all arise from the STIC lesion located in fimbriae of uterine tube.