Toward understanding the natural history of ovarian carcinoma development: a clinicopathological approach
Toward understanding the natural history of ovarian carcinoma development: a clinicopathological approach
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DOI：
10.1016/s0090-8258(02)00104-x
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发表时间：
2003-03-01
影响因子：
4.7
通讯作者：
Konishi, I
中科院分区：
文献类型：
--
作者：
Horiuchi, A;Itoh, K;Konishi, I
Objective.卵巢癌的自然发展史尚不清楚。卵巢癌是由良性和/或交界性恶性肿瘤发展而来，还是从卵巢表面上皮原发，目前尚不清楚。为了解决这些问题的临床病理学，我们审查了543例上皮性卵巢癌患者和252例交界性肿瘤患者的临床图表，他们在7家医院接受了剖腹手术，并收集了手术前12个月或更短时间内附件区域的临床和经阴道超声检查（USG）结果。对切除标本的组织学切片进行再检查，以确定诊断和组织学分级，以及癌旁是否存在良性或边缘样病变。49例患者在剖腹手术前12个月或更短时间内接受了经阴道超声检查。其中癌35例（浆液性11例，粘液性6例，透明细胞8例，类浆液性10例），交界性肿瘤14例（浆液性8例，粘液性6例）。在35例癌患者中，19例（54%）因良性囊肿或增生性囊肿而随访。在这些病例中，连续USG检查显示囊肿实体部分的大小和/或外观增加。然而，在其余16例（46%）中，USG无明显异常，此类病例最常见于浆液性癌。我们的研究结果表明，大约一半的卵巢癌继发于先前存在的良性囊肿或增生性囊肿，而其余一半似乎是从正常卵巢突然发展而来。这似乎与卵巢癌发展的两种可能途径一致;腺瘤-癌序列和从头致癌。(C)2003 Elsevier Science（美国）。All rights reserved.
Objective. The natural history of the development of ovarian carcinoma is not known. It also remains undetermined whether ovarian carcinomas develop from benign and/or borderline malignant tumors or arise de novo from the ovarian surface epithelium.Methods. To address these issues clinicopathologically, we reviewed the clinical charts of 543 patients with epithelial ovarian carcinoma and 252 patients with borderline tumors who underwent laparotomy at seven hospitals and collected patients whose clinical and transvaginal ultrasonography (USG) findings for adnexal regions 12 months or fewer prior to the surgery were available. Histological slides of the resected specimens were reexamined concerning the diagnosis and histological grade, as well as the presence or absence of benign- or borderline-like lesions adjacent to the carcinoma.Results. Forty-nine patients had had gynecological examination with transvaginal USG 12 months or fewer prior to laparotomy. Among them, 35 had carcinomas (11 serous, 6 mucinous, 8 clear cell, 10 endometrioid) and 14 had borderline tumors (8 serous, 6 mucinous). Of the 35 patients with carcinoma, 19 (54%) had been followed up for benign-appearing cysts or endometriotic cysts. In these cases, serial USG examinations revealed an increase in size and/or appearance of the solid part of the cyst. In the remaining 16 (46%), however, there had been no apparent abnormalities in USG, and such cases occurred most frequently for serous carcinomas.Conclusion. Our findings suggest that approximately half of ovarian carcinomas develop secondarily from preexisting, benign-appearing cysts or endometriotic cysts, whereas the remaining half seem to develop suddenly from a normal-appearing ovary. This appears to be consistent with two possible pathways of ovarian carcinoma development; adenoma-carcinoma sequence and de novo carcinogenesis. (C) 2003 Elsevier Science (USA). All rights reserved.