ENDOMETRIAL CARCINOMA IN-SITU IN POSTMENOPAUSAL WOMEN
ENDOMETRIAL CARCINOMA IN-SITU IN POSTMENOPAUSAL WOMEN
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DOI：
10.1097/00000478-199504000-00003
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发表时间：
1995-04-01
影响因子：
5.6
通讯作者：
SPIEGEL, GW
中科院分区：
文献类型：
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作者：
SPIEGEL, GW
在对518例子宫内膜癌和39例癌肉瘤的未辐照子宫切除术标本的回顾中，有86例发现显微镜下有恶性上皮灶，但未能改变原本薄的萎缩或弱增殖的子宫内膜或子宫内膜息肉的结构。这些变化被解释为子宫内膜原位癌（ECIS）。这种变化出现在表面（SCIS）、孤立腺体（GCIS）和小组（3 - 5组）腺体（薄AH）中。对于这三种亚型，既没有乳头状突起，也没有基质反应，也没有腺上皮桥接。当它们存在并且没有间质反应或反应仅限于一个或两个腺体，没有子宫内膜浸润或子宫内膜结构改变时，它们被指定为薄癌（thin CA），这是ECIS的第四种亚型。这些患者的年龄范围为50-90岁，平均和中位年龄分别为66岁和65岁。除一名患者外，所有患者均已绝经。66%的子宫内膜恶性肿瘤为子宫乳头状浆液/透明细胞癌（UPS）或含有UPS成分。ECIS病灶出现在肿瘤附近的占86%，与肿瘤分离的占59%，弥漫性的占16%。我们认为，在许多绝经后妇女中，表面上皮或个别腺体发生恶性转化，然后发展为侵袭性恶性肿瘤，而没有非典型增生的中间阶段，特别是在有UPS因素的病例中。
In a review of 518 nonirradiated hysterectomy specimens with endometrial carcinoma and 39 with carcinosarcoma, 86 cases were identified in which there were microscopic foci of malignant epithelium that failed to alter the architecture of an otherwise thin atrophic or weakly proliferative endometrium or endometrial polyp. These changes were interpreted to be endometrial carcinoma in situ (ECIS). This change was present on the surface (SCIS), in isolated glands (GCIS), and in small (three to five) groups of glands (thin AH). For these three subtypes, neither papillations, stromal reaction, nor glandular epithelial bridging were present. When they were present and there was either no stromal reaction or the reaction was limited to one or two glands in the absence of myometrial invasion or endometrial architectural alteration, they were designated as thin carcinoma (thin CA), a fourth subtype of ECIS. For these patients the age range was 50-90 years, with mean and median ages of 66 and 65 years, respectively. All but one patient was known to be postmenopausal. In 66% of cases the endometrial malignancy either was uterine papillary serous/clear cell carcinoma (UPS) or contained an element of UPS. Foci of ECIS were present adjacent to the tumor in 86%, isolated from the tumor in 59%, and diffuse in 16% of cases. It is proposed that in many postmenopausal women, either surface epithelium or individual glands undergo malignant transformation and then progress to an invasive malignancy without an intervening phase of atypical hyperplasia, particularly in cases with an element of UPS.