Squamous metaplasia of the ovarian surface epithelium and subsurface fibrosis: Distinctive pathologic findings in the ovaries and fallopian tubes of patients on peritoneal dialysis
Squamous metaplasia of the ovarian surface epithelium and subsurface fibrosis: Distinctive pathologic findings in the ovaries and fallopian tubes of patients on peritoneal dialysis
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DOI：
10.1097/pgp.0b013e3181671aad
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发表时间：
2008-10-01
影响因子：
2.4
通讯作者：
Zaloudek, Charles J.
中科院分区：
文献类型：
--
作者：
Hosfield, Elizabeth M.;Rabban, Joseph T.;Zaloudek, Charles J.
腹膜透析通常用于治疗终末期肾病患者。长期腹膜透析的患者会出现腹膜水肿和纤维化，但对女性生殖道器官的形态学影响尚不清楚。我们注意到一例腹膜透析患者的卵巢表面上皮鳞状上皮化生，因此我们回顾了手术病理数据库中所有腹膜鳞状上皮化生病例。鳞状上皮化生的腹膜是罕见的，我们发现只有3例。2例发生于长期腹膜透析的女性，因良性卵巢囊腺瘤而手术。两例病例的妇科病理学结果相似，卵巢表面广泛存在未成熟和成熟鳞状上皮化生，1例病例在同侧输卵管表面。化生上皮为角蛋白和p63阳性。p63染色突出了化生上皮仅为1或2细胞层厚的区域和更发达的化生区域。此外，在表面下方有1- 2 mm厚的宽纤维组织带。第三例腹膜鳞状上皮化生涉及一名女性的小肠浆膜表面，该女性在减肥手术后出现并发症。在小肠浆膜表面上和下面有鳞状化生上皮小结节，周围有急性和慢性炎症和纤维化。根据我们的经验和文献中有限的信息，腹膜鳞状化生有2种不同的模式：腹膜透析患者中与带状皮下纤维化相关的弥漫性化生模式和与炎症性疾病相关的微模块化化生模式。涉及卵巢和输卵管的透析相关变化形成机械屏障，可能导致腹膜透析患者生育率低。
Peritoneal dialysis is commonly used to treat patients with end-stage renal disease. Patients on long-term peritoneal dialysis develop edema and fibrosis of the peritoneal membrane, but the morphologic effects on the organs of the female genital tract are obscure. We noted squamous metaplasia of the ovarian surface epithelium in a patient on peritoneal dialysis, leading us to review all cases of peritoneal squamous metaplasia in our surgical pathology database. Squamous metaplasia of the peritoneum is rare, and we found only 3 examples. Two cases occurred in women oil long-term peritoneal dialysis who were operated on for benign ovarian cystadenomas. The gynecologic pathology findings were similar in both cases, with immature and mature squamous metaplasia present extensively on the surfaces of the ovaries, and in I case, on the surface of the ipsilateral fallopian tube. The metaplastic epithelium was keratin and p63 positive. Staining for p63 highlighted areas where the metaplastic epithelium was only 1- or 2-cell layers thick and areas of more developed metaplasia. In addition, there was a broad band of fibrous tissue 1- to 2-mm thick beneath the surfaces. A third case of peritoneal squamous metaplasia involved the serosal surface of the small intestine in a woman who experienced complications after bariatric surgery. There were small nodules of squamous metaplastic epithelium on and beneath the serosal surface of the intestine, surrounded by acute and chronic inflammation and fibrosis. Based on our experience and limited information in the literature, there are 2 distinct patterns of squamous metaplasia of the peritoneum: a diffuse pattern of metaplasia associated with bandlike subsurface fibrosis in peritoneal dialysis patients and a micromodular pattern of metaplasia associated with inflammatory conditions. Dialysis-associated changes involving the ovary and fallopian tube form a mechanical barrier that could contribute to the low rate of fertility in peritoneal dialysis patients.