卵巢原发性鳞状细胞癌15例临床病理学特征及预后分析

Primary ovarian squamous cell carcinoma:clinicopathological features and prognostic analysis of fifteen cases

目的探讨卵巢原发性鳞状细胞癌(POSCC)的临床病理学特征及预后。方法收集2009年1月至2018年12月中国科学院大学附属肿瘤医院诊治的15例卵巢原发性鳞状细胞癌,通过免疫组织化学法检测p16、hMLH1、hMSH2、hMSH6、PMS2在POSCC中的表达,RNAscope原位杂交技术检测POSCC中18种高危型人乳头状瘤病毒(HPV)。结果15例病例中可见不同分化程度的鳞状细胞癌,包括高分化3例,中-低分化12例。肿瘤周围4例可见原位鳞状细胞癌,4例可见畸胎瘤成分,1例可见子宫内膜样癌/不典型增生成分,1例可见子宫内膜异位腺体。5例(5/15)p16表达阳性且原位杂交证实有高危型HPV感染,其余10例p16阴性病例原位杂交均未检测到高危型HPV感染。所有病例均无错配修复蛋白缺失。与无感染HPV患者相比,伴有高危型HPV感染患者的总生存时间(P=0.038)及无进展生存时间(P=0.045)较长。结论POSCC多见于绝经后女性,常为单侧发生,血清学指标CA125及鳞状细胞癌抗原(SCC)上升最常见。形态学上肿瘤呈现不同的分化程度,但目前的数据表明分化程度并不能作为患者的独立预后指标。高危型HPV感染可能与POSCC的发生相关,而且伴有高危型HPV感染的POSCC患者预后优于无感染的患者。

Objective To assess the clinical features and treatment outcomes in patients with primary ovarian squamous cell carcinoma(POSCC).Methods Fifteen patients with primary ovarian squamous cell carcinoma diagnosed from January 2009 to December 2018 in Cancer Hospital of the University of Chinese Academy of Sciences were collected.The expression of p16,hMLH1,hMSH2,hMSH6 and PMS2 in POSCC was detected by immunohistochemistry,and the status of high-risk human papillomavirus(HPV)by RNAscope test.Results Squamous cell carcinoma with different degrees of differentiation was found in 15 cases,including three cases with high differentiation and 12 cases with medium to low differentiation.There were four cases with in situ squamous cell carcinoma,four cases with teratoma,one case with endometrial carcinoma/atypical hyperplasia,and one case with endometriosis.p16 was expressed in five cases(5/15),indicating coexisting high-risk HPV infection.There was no high-risk HPV infection in the remaining 10 cases,and p16 staining was negative.There was no deficient mismatch repair protein in all cases.The overall survival time(P=0.038)and progression free survival(P=0.045)of patients with high-risk HPV infection were longer than those without HPV infection.Conclusions POSCC is more commonly noted in postmenopausal women and often occurs unilaterally.Elevated serological indexes CA125 and SCC are the most common finding.Morphologically,the tumors show variable degrees of differentiation,but the current data suggest that the degree of differentiation cannot be used as an independent prognostic index.High-risk HPV infection may be associated with the occurrence of POSCC,and that the prognosis of POSCC patients with HPV infection is better than that of patients without infection.