9例子宫内膜和卵巢同步癌的临床病理特征

Clinicopathological features of 9 cases of synchronous endometrial and ovarian cancer

目的 探讨子宫内膜和卵巢同步癌(SEOC)的临床病理特征。方法 回顾性分析2009年8月至2020年8月经手术切除并经病理组织学证实的9例SEOC患者的临床病理资料,分析其临床病理特征并复习相关文献。结果 患者年龄29~65岁,平均年龄47.44岁,首发症状以子宫异常出血为主。9例SEOC患者子宫内膜癌的病理类型均为子宫内膜样癌,以低级别、Ⅰ期肿瘤为主;8例伴子宫内膜非典型增生/子宫内膜上皮内瘤变(AH/EIN)。9例SEOC中,卵巢癌的病理类型为低级别子宫内膜样癌(G1、G2)8例,透明细胞癌1例;均为Ⅰ期肿瘤,多为单侧卵巢受累。6例存在卵巢子宫内膜异位症。均无淋巴脉管间隙浸润及输卵管受累。4例患者行腹水细胞学检查,仅1例发现癌性腹水。其中病例5既往有结肠腺癌病史,子宫内膜癌、卵巢癌及结肠腺癌免疫组化结果显示MLH1、PMS2表达缺失;病例8卵巢癌病理类型为透明细胞癌,子宫内膜癌及卵巢癌免疫组化结果显示MSH2、MSH6表达缺失。所有患者均接受手术治疗及术后辅助治疗。结论 SEOC通常发生于年轻女性。以低级别子宫内膜样癌、早期肿瘤为主。治疗以手术切除为主,患者预后良好。

Objective To investigate the clinicopathological features of synchronous endometrial and ovarian cancer(SEOC). Methods The clinicopathological data of 9 cases of pathologically proven SEOC from August 2009 to August 2020 were analyzed retrospectively. The clinicopathological features were discussed and related literatures were reviewed. Results All patients aged from 29 to 65 years with a mean of 47.44 years old, and the first symptoms were mainly abnormal uterine bleeding. All of the endometrial cancers were low grade endometrioid carcinomas, and mainly FIGO Grade 1(G1), stageⅠ. Eight patients were accompanied by endometrial atypical hyperplasia/endometrioid intraepithelial neoplasia(AH/EIN). As to ovarian cancers, 8 were low grade endometrioid carcinomas(G1and G2) and 1 was clear cell carcinoma. All were stageⅠcancers. Most were unilateral ovarian involvement, and 6 patients accompanied by ovarian endometriosis. All patients had no lymphatic vessel space invasion(LVSI) or fallopian tube involvement. Four patients underwent ascites cytology, only 1 case was found positive peritoneal cytology. Mismatch repair(MMR) deficiency was found in two patients. In Case 5, the patient had a history of colon adenocarcinoma and the expression of MLH1 and PMS2 was lost in endometrial cancer, ovarian cancer and colon adenocarcinoma immunohistochemistry. In Case 8, the pathological type of ovarian cancer was clear cell carcinoma and the expression of MSH2 and MSH6 was lost in endometrial and ovarian cancer immunohistochemistry. All patients received surgical treatment and postoperative adjuvant therapy. Conclusion SEOC usually occurs in young women. The histological type was low grade endometrioid carcinoma and low pathological stage. Surgical resection was the main treatment, and the prognosis was good.