Nodal Endosalpingiosis in Ovarian Serous Tumors of Low Malignant Potential With Lymph Node Involvement: A Case for a Precursor Lesion
Nodal Endosalpingiosis in Ovarian Serous Tumors of Low Malignant Potential With Lymph Node Involvement: A Case for a Precursor Lesion
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DOI：
10.1097/pas.0b013e3181f17d33
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发表时间：
2010-10-01
影响因子：
5.6
通讯作者：
Malpica, Anais
中科院分区：
文献类型：
--
作者：
Djordjevic, Bojana;Clement-Kruzel, Stacia;Malpica, Anais
低恶性潜能卵巢浆液性肿瘤（OSLMP）的淋巴结累及（LNI）患者占22%。LNI的起源一直是文献中争论的主题。本研究的目的是探讨结节性输卵管内肿大在该疾病发病机制中的作用。我们首先检查了30例OSLMP病例、30例宫颈腺癌病例和30例子宫内膜子宫内膜样腺癌病例中结节性输卵管内肿大的发生频率。与宫颈肿瘤（0%,P < 0.0001）和子宫内膜肿瘤（3%,P = 0.0015）相比，OSLMP病例的结节性输卵管内肿大率（33%）显著高于宫颈肿瘤（0%,P < 0.0001）。然后，我们比较了36例伴有LNI的OSLMP和36例无LNI的OSLMP中淋巴结性输卵管内肿大的发生率。伴有LNI的OSLMP的结节性输卵管内肿大率（66%）明显高于无LNI的OSLMP （14%, P < 0.0001）。我们进一步研究了伴有LNI的OSLMP队列病例，记录了每个病例中每个淋巴结的结节性输卵管内肿大和LNI的存在。本分析显示，淋巴结性输卵管内肿大和LNI同时出现在同一淋巴结的发生率远高于单独随机发生的发生率（OR = 71.2, P < 0.0001）。最后，在有LNI的OSLMP案例中，我们记录了LNI模式的类型。我们发现，结节性输卵管内肿大的病例（50%）比无结节性输卵管内肿大的病例（8%,P = 0.0253）发生率更高。总体而言，36%的OSLMP合并LNI病例出现肾小球内型。在这项研究中，我们发现淋巴结性输卵管内肿大不仅在OSLMP中比其他缪勒氏管恶性肿瘤更常见，而且在有LNI的OSLMP中也比没有LNI的OSLMP更常见。我们首次证明了输卵管内肿大与LNI腺内类型之间具有统计学意义的关联，并且我们提出，在高达三分之一的OSLMP和LNI患者中，低恶性潜能浆液性肿瘤的淋巴结灶可能独立于结节性输卵管内肿大。这一结果有助于理解卵巢外卵巢疾病在OSLMP病例中的发病机制，并对患者管理和随访具有重要意义。
Lymph node involvement (LNI) in ovarian serous tumors of low malignant potential (OSLMP) upstages 22% of patients. The origin of LNI has been a subject of debate in the literature. The purpose of this study was to investigate the role of nodal endosalpingiosis in the pathogenesis of this entity. We first examined the frequency of nodal endosalpingiosis in 30 OSLMP cases, 30 cervical adenocarcinoma cases, and 30 endometrial endometrioid adenocarcinoma cases. The rate of nodal endosalpingiosis was significantly higher in OSLMP cases (33%) compared with both cervical (0%, P < 0.0001) and endometrial tumor cases (3%, P = 0.0015). We then compared the frequency of nodal endosalpingiosis in 36 cases of OSLMP with LNI and 36 cases of OSLMP without LNI. The rate of nodal endosalpingiosis was significantly higher in OSLMP with LNI (66%) than in OSLMP without LNI (14%, P < 0.0001). We further investigated the cohort cases of OSLMP with LNI by recording the presence of nodal endosalpingiosis and LNI in each individual lymph node in every case. This analysis revealed that nodal endosalpingiosis and LNI appear together in the same lymph nodes at a much higher rate than would be expected by random chance alone (OR = 71.2, P < 0.0001). Lastly, in OSLMP cases with LNI, we recorded the types of LNI patterns. We found that the intraglandular pattern was present in a higher percentage of cases with nodal endosalpingiosis (50%) than in cases without nodal endosalpingiosis (8%, P = 0.0253). Overall, the intraglandular pattern of LNI appeared in 36% of OSLMP cases with LNI. In this study, we show that nodal endosalpingiosis not only occurs more commonly in OSLMP compared with other Mullerian malignancies, but also in OSLMP with LNI compared with OSLMP without LNI. For the first time, we demonstrate a statistically significant association between endosalpingiosis and the intraglandular pattern of LNI, and we propose that in up to a third of patients with OSLMP and LNI, nodal foci of serous tumor of low malignant potential may derive independently, from nodal endosalpingiosis. This result contributes to the understanding of the pathogenesis of extraovarian disease in cases of OSLMP and has important implications for patient management and follow-up.