Architectural Patterns of Ovarian/Pelvic High-grade Serous Carcinoma
Architectural Patterns of Ovarian/Pelvic High-grade Serous Carcinoma
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DOI：
10.1097/pgp.0b013e31824c2372
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发表时间：
2012-09-01
影响因子：
2.4
通讯作者：
Koebel, Martin
中科院分区：
文献类型：
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作者：
Bromley, Amy B.;Altman, Alon D.;Koebel, Martin
我们描述了晚期卵巢/盆腔高级别浆液性癌的结构模式，这些癌先接受手术治疗，然后进行辅助化疗或新辅助化疗，然后进行间隔减瘤，以探讨与化疗反应的关系。对于 70 例晚期（即 III/IV 期）高级别浆液性癌（33 例铂类耐药/中度，37 例铂类敏感；24 例新辅助治疗，44 例初次手术），所有含肿瘤的组织学切片均由 3 名病理学家中的 1 名进行审查。组织学类型得到确认，并评估以下特征：主要结构模式和 8 种预定义的次要结构模式中任何一种的存在（乳头状、移行细胞癌样、微乳头状、微囊性、嵌套乳头状、狭缝状、腺状、实性）。对砂粒体、组织细胞反应、坏死、核异型性和单细胞侵袭进行半定量评估。在10个HPF中进行有丝分裂计数，并在1个HPF中对上皮内淋巴细胞进行计数。测试了形态学特征与既往新辅助化疗和化疗反应的相关性（通过新辅助化疗分层的耐药/中间与化疗敏感病例），这是使用分类变量的 chi(2) 检验和连续数据的方差分析进行的。使用无监督聚类（Wald）分析特征组合。尽管将新辅助治疗患者的样本与之前未接受治疗的患者的样本进行比较时，18 个特征中有 8 个存在显着差异，但没有单独的组织形态学特征或特征组合与化疗反应相关。高级别浆液性癌的进一步分型可能需要辅助分子标记，这些标记可能更有潜力识别对铂类化疗无反应的病例。
We describe the architectural patterns of advanced ovarian/pelvic high-grade serous carcinomas that have been treated with upfront surgery, followed by adjuvant chemotherapy or neoadjuvant chemotherapy, followed by interval debulking to explore the association with the chemotherapeutic response. For 70 cases of advanced (i.e. stage III/IV) high-grade serous carcinomas (33 platinum resistant/intermediate, 37 platinum sensitive; 24 neoadjuvantly treated, 44 primary surgery), all tumor-containing histologic slides were reviewed by 1 of 3 pathologists. Histologic type was confirmed and the following features were assessed: major architectural pattern and the presence of any of 8 predefined minor architectural patterns (papillary, transitional cell carcinoma-like, micropapillary, microcystic, nested papillary, slit-like, glandular, solid). A semi-quantitative assessment of psammoma bodies, histiocytic response, necrosis, nuclear atypia, and single-cell invasion was performed. Mitotic count was performed in 10 HPF and 1 HPF was counted for intraepithelial lymphocytes. The morphologic features were tested for an association with previous neoadjuvant chemotherapy and response to chemotherapy (resistant/intermediate versus chemotherapy-sensitive cases stratified by neoadjuvant chemotherapy), which was carried out using chi(2) tests for categorical variables and analysis of variance for continuous data. Combinations of features were analyzed using unsupervised clustering (Wald). Although 8 of 18 features were significantly different when samples from neoadjuvantly treated patients were compared with those not previously treated, no individual histomorphologic feature or a combination of features was associated with response to chemotherapy. Further subtyping of high-grade serous carcinomas will likely need ancillary molecular markers that may have a greater potential to identify cases that will not respond to platinum-based chemotherapy.