Diagnostic Criteria and Behavior of Ovarian Seromucinous (Endocervical-Type Mucinous and Mixed Cell-Type) Tumors: Atypical Proliferative (Borderline) Tumors, Intraepithelial, Microinvasive, and Invasive Carcinomas
Diagnostic Criteria and Behavior of Ovarian Seromucinous (Endocervical-Type Mucinous and Mixed Cell-Type) Tumors: Atypical Proliferative (Borderline) Tumors, Intraepithelial, Microinvasive, and Invasive Carcinomas
复制标题
卵巢浆液粘液性（宫颈内膜型粘液性和混合细胞型）肿瘤的诊断标准和行为：非典型增殖性（交界性）肿瘤、上皮内癌、微侵袭性癌和侵袭性癌
DOI：
--
复制
发表时间：
2002
影响因子：
5.6
通讯作者：
R. Kurman
中科院分区：
文献类型：
--
作者：
H. Shappell;M. Riopel;A. E. Smith Sehdev;B. Ronnett;R. Kurman
迄今为止报道的卵巢宫颈内型（m<s:1>勒勒氏）黏液性肿瘤和由宫颈内型黏液性、浆液性、子宫内膜样细胞、鳞状细胞和嗜酸性细胞质丰富的无差异细胞混合组成的肿瘤主要局限于交界型和微创型，仅有一例与疾病相关的死亡报告。本文对54例宫颈内型和混合细胞型黏液性肿瘤的临床病理特征进行了评价，这些肿瘤的定义是具有类似浆液性肿瘤的乳头状结构，但含有宫颈内型黏液上皮。34例肿瘤（64%）被分类为非典型增生（交界性）肿瘤，基于无间质浸润和无微乳头状结构，尺寸为bbbb5 mm。5例肿瘤（9%）为上皮内癌，基于明显的细胞学异型性或复杂的筛状生长模式，包括覆盖乳头表面或内衬囊腔的上皮。8例（15%）间质浸润≤5mm归为微侵性癌。7例（13%）间质浸润（5例）或微乳头状结构（2例）为癌。16例（30%）为双侧肿瘤，其中41%为输卵管内肿大。所有病例均存在浆液型分化。29例非典型增生性肿瘤、上皮内癌和微侵袭性癌患者随访后，无疾病相关死亡。相比之下，在7例肿瘤有间质浸润或微乳头状结构bb0.5 mm的患者中，2例III期患者死于疾病（1例有明显浸润，1例有微乳头状肿瘤无间质浸润）。另一名患有非侵袭性微乳头状癌的III期患者在84个月时存活。其余4例患者（3例I期和1例III期）存活，无疾病迹象。总之，大多数宫颈内型非典型增生性肿瘤为I期良性肿瘤。上皮内癌或微侵袭的存在对行为没有不良影响。罕见的宫颈内黏液型肿瘤表现出组织学上的恶性特征和侵袭性行为，可以确定为癌。与浆液性肿瘤一样，宫颈内型黏液性肿瘤中无明显侵袭的微乳头状结构与晚期疾病的复发和死亡相关。本研究中所有肿瘤均由异质细胞群组成，主要由浆液型（纤毛型）和宫颈内型粘液细胞组成。此外，它们都含有子宫内膜样细胞、鞋钉细胞和不同程度丰富的嗜酸性细胞质的无关细胞。因此，以宫颈内黏液细胞为特征的肿瘤很少是纯的，而几乎都是混合细胞。尽管含有黏液上皮，但宫颈内型黏液性肿瘤的乳头状结构、浆液型分化、与输卵管内肿大的关联、频繁的双侧性、大小和临床行为与浆液性肿瘤非常相似。因此，我们建议用“浆液性”一词来形容这些肿瘤，这同时承认了它们的浆液性和黏液性特征。
Ovarian endocervical-type (müllerian) mucinous tumors and tumors composed of a mixture of endocervical-type mucinous, serous, endometrioid, squamous, and indifferent cells with abundant eosinophilic cytoplasm reported to date have been primarily limited to borderline and microinvasive types, with only one report of a disease-related death. The clinicopathologic features of 54 endocervical-type and mixed cell-type mucinous tumors, defined as tumors with papillary architecture resembling serous tumors but containing endocervical-type mucinous epithelium, were evaluated. Thirty-four tumors (64%) were classified as atypical proliferative (borderline) tumors based on the absence of stromal invasion and the absence of micropapillary architecture measuring >5 mm. Five tumors (9%) qualified as intraepithelial carcinoma based on the presence of marked cytologic atypia or a complex cribriform growth pattern involving the epithelium covering the surface of papillae or lining cystic spaces. Eight tumors (15%) with stromal invasion ≤5 mm were classified as microinvasive carcinoma. Seven tumors (13%) with either stromal invasion (five tumors) or micropapillary architecture measuring >5 mm (two tumors) were classified as carcinoma. Sixteen tumors (30%) were bilateral, and endosalpingiosis was identified in 41% of cases. Serous-type differentiation was present in all cases. Of the 29 patients with atypical proliferative tumors, intraepithelial carcinomas, and microinvasive carcinomas for whom follow-up was available, there were no disease-related deaths. In contrast, of the seven patients whose tumors had either stromal invasion or micropapillary architecture >5 mm, two stage III patients died of disease (one with frank invasion and one with a micropapillary tumor that lacked stromal invasion). One other stage III patient with a noninvasive micropapillary carcinoma was alive with disease at 84 months. The remaining four patients (three stage I and one stage III) were alive with no evidence of disease. In summary, most endocervical-type atypical proliferative tumors are stage I and benign. The presence of either intraepithelial carcinoma or microinvasion has no adverse effect on behavior. Rare endocervical-type mucinous tumors demonstrate histologically malignant features and aggressive behavior that warrant designation as carcinoma. As with serous tumors, micropapillary architecture without frank invasion in endocervical-type mucinous tumors is associated with disease recurrence and death when presenting as advanced-stage disease. All the tumors in this study were composed of a heterogeneous population of cells, consisting mainly of serous (ciliated) and endocervical-type mucinous cells. In addition, they all contained endometrioid-type cells, hobnail cells, and indifferent cells with abundant eosinophilic cytoplasm to a varying degree. Accordingly, it appears that tumors that feature endocervical-type mucinous cells are rarely if ever pure but almost invariably of mixed cell type. Despite containing mucinous epithelium, the papillary architecture, serous-type differentiation, association with endosalpingiosis, frequent bilaterality, size, and clinical behavior of endocervical-type mucinous tumors closely resemble serous tumors. We therefore recommend the term “seromucinous” for these tumors, which acknowledges both their serous and mucinous features.