Adenomatoid tumour of the uterus is frequently associated with iatrogenic immunosuppression
Adenomatoid tumour of the uterus is frequently associated with iatrogenic immunosuppression
复制标题
子宫腺瘤样肿瘤通常与医源性免疫抑制有关
DOI：
10.1111/his.13726
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发表时间：
2018
期刊：
影响因子：
6.4
通讯作者：
Goto Akiteru
中科院分区：
文献类型：
--
作者：
Tamura Daisuke;Maeda Daichi;Halimi Sultan Ahmad;Okimura Masato;Kudo-Asabe Yukitsugu;Ito Satoru;Sato Naoki;Shibahara Junji;Nanjo Hiroshi;Terada Yukihiro;Goto Akiteru
子宫腺瘤样瘤（AT）是一种良性增生的细胞，表现为子宫肌层间皮分化，通常表现为单个结节。罕见的弥漫性子宫房性心动过速已被报道，通常发生在接受免疫抑制治疗的患者中。在此，我们的目的是阐明子宫AT和医源性免疫抑制的发病率之间的一般关联队列analysis.Methods和resultsWe分析了611个连续子宫切除术标本，以确定AT的发病率及其与免疫抑制状态的相关性。通过原位杂交和免疫组化检测间皮细胞谱系、p16表达、错配修复（MMR）蛋白改变以及致瘤病毒的可能整合。在611例子宫切除术患者中，14例（2.3%）检测到AT。免疫抑制（IS）组AT的发生率（5/20，25.0%）显著高于非IS组（9/591，1.52%），相对风险为16.4。IS组的5例房性心动过速中，3例为多灶性或弥漫性。在4例免疫抑制尸检病例中的1例中，通过全切片检测到潜伏性子宫AT。AT的肿瘤细胞普遍表达钙视网膜蛋白和podoplanin。在大多数AT中观察到p16的特征性阻滞型（≥90%）阳性。所有AT的人疱疹病毒8型、默克尔细胞多瘤病毒、SV 40大T抗原、爱泼斯坦-巴尔病毒和人乳头瘤病毒均为阳性，并且保留了MMR蛋白。桑格测序发现ATRAF 7突变是从12个AT的宏观解剖组织中鉴定的。结论子宫AT是一种免疫抑制相关的间皮瘤病变，其特征是p16过度表达。
AimsUterine adenomatoid tumour (AT) is a benign proliferation of cells showing mesothelial differentiation within the myometrium that usually presents as a single nodule. Rare diffuse uterine ATs have been reported, often in patients undergoing immunosuppressive therapy. Herein, we aimed to elucidate the general association between the incidence of uterine AT and iatrogenic immunosuppression by cohort analysis.Methods and resultsWe analysed 611 consecutive hysterectomy specimens to determine the incidence of AT and its correlation with the immunosuppressive status. Mesothelial lineage, p16 expression, mismatch repair (MMR) protein alterations, and the possible integration of tumorigenic viruses were examined byin situhybridizasion and immunohistochemistry. ATs were detected in 14 of 611 hysterectomy cases (2.3%). The incidence of AT was significantly higher in the immunosuppressed (IS) group (5/20, 25.0%) than in the non‐IS group (9/591, 1.52%), with a relative risk of 16.4. Of the five ATs in the IS group, three were multifocal or diffuse. Latent uterine AT was detected, byin totosectioning, in one of four immunosuppressed autopsy cases. The tumor cells of ATs commonly expressed calretinin and podoplanin. Characteristic block‐type (≥90%) positivity for p16 was observed in most ATs. None of the ATs were positive for human herpes virus type 8, Merkel cell polyomavirus, SV40 large T antigen, Epstein‐Barr virus, and human papilloma virus, and the MMR proteins were retained. ATRAF7mutation was identified from macrodissected tissue in one of 12 ATs by Sanger sequencing.ConclusionUterine AT is an immunosuppression‐associated mesothelial lesion characterised by p16 overexpression.