Ovarian Cancer Is an Imported Disease: Fact or Fiction?
Ovarian Cancer Is an Imported Disease: Fact or Fiction?
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DOI：
10.1007/s13669-011-0004-1
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发表时间：
2012-03
影响因子：
0.5
通讯作者：
Shih, Ie-Ming
中科院分区：
文献类型：
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作者：
Kuhn, Elisabetta;Kurman, Robert J;Shih, Ie-Ming
卵巢癌的起源细胞一直争论不休。目前的研究范式是上皮性卵巢癌（EOC）起源于卵巢表面上皮（OSE）。OSE是由扁平的、难以描述的细胞组成，与腹膜腔内的间皮细胞更相似，并与之连续，而不是各种组织学类型的卵巢癌（浆液性、子宫内膜样癌和透明细胞癌），它们具有<s:1>勒氏型表型。因此，有人认为OSE经历了一个称为“化生”的过程，以解释这种深刻的形态转变。最近的分子和临床病理学研究不仅未能支持这一假设，而且还提供了证据表明EOC起源于<s:1>勒氏细胞衍生的卵巢外细胞，继发累及卵巢，因此对原发性EOC的存在提出了质疑。这一新的卵巢癌发生模型提出输卵管上皮（良性或恶性）植入卵巢产生高级别和低级别浆液性癌，子宫内膜组织植入卵巢产生子宫内膜异位症，子宫内膜异位症可恶性转化为子宫内膜样癌和透明细胞癌。因此，EOC最终不是起源于卵巢，而是继发性的，因此可以合理地得出结论，唯一真正的原发性卵巢肿瘤是类似于睾丸肿瘤的生殖细胞和性腺间质肿瘤。如果这个新模型得到证实，它将对“卵巢癌”的早期发现和治疗产生深远的影响。
The cell of origin of ovarian cancer has been long debated. The current paradigm is that epithelial ovarian cancer (EOC) arises from the ovarian surface epithelium (OSE). OSE is composed of flat, nondescript cells more closely resembling the mesothelium lining the peritoneal cavity, with which it is continuous, rather than the various histologic types of ovarian carcinoma (serous, endometrioid, and clear cell carcinoma), which have a Müllerian phenotype. Accordingly, it has been argued that the OSE undergoes a process termed “metaplasia” to account for this profound morphologic transformation. Recent molecular and clinicopathologic studies not only have failed to support this hypothesis but also have provided evidence that EOC stems from Müllerian-derived extraovarian cells that involve the ovary secondarily, thereby calling into question the very existence of primary EOC. This new model of ovarian carcinogenesis proposes that fallopian tube epithelium (benign or malignant) implants on the ovary to give rise to both high-grade and low-grade serous carcinomas, and that endometrial tissue implants on the ovary and produces endometriosis, which can undergo malignant transformation into endometrioid and clear cell carcinoma. Thus, ultimately EOC is not ovarian in origin but rather is secondary, and it is logical to conclude that the only true primary ovarian neoplasms are germ cell and gonadal stromal tumors analogous to tumors in the testis. If this new model is confirmed, it has profound implications for the early detection and treatment of “ovarian cancer.”