协和医学杂志

2012, (01)

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原发于腹膜和卵巢的浆液性乳头状腺癌临床病理
Clinicopathological Features and Immunohistochemical Comparison of Primary Peritoneal and Primary Ovarian Serous Papillary Carcinoma

曾瑄;高洁;梁智勇;张静

摘要(Abstract):

目的 分析比较原发性腹膜和卵巢的浆液性乳头状腺癌的临床病理特征及免疫组化表达的特点。方法 选取我院手术切除的10例符合原发性腹膜浆液性乳头状腺癌(primary peritoneal serous papillary carcinoma,PPSPC)定义的病例,以及20例与之配对的卵巢浆液性乳头状腺癌(ovarian serous papillary cancer,OSPC),分析二者的临床病理学特点,用免疫组织化学染色(EnVision法)观察雌激素受体(ER)、孕激素受体(PR)、HER-2以及p53蛋白的表达;并采用荧光原位杂交(FISH)检测二者HER-2基因状态。结果 PPSPC患者的平均发病年龄较OSPC患者的平均发病年龄大8.3岁,经统计学分析,二者在年龄分布上存在显著统计学差异(p=0.045)。PPSPCs中60%为低分化浆液性癌,而OSPCs中的低分化癌仅占25%,二者具有明显统计学差异(p=0.045)。免疫化学结果显示:ER和PR在PPSPCs中的表达(分别为60 %,10%)明显低于OSPCs(分别为95 %,50%,p=0.031,p=0.032)。p53在二者中的表达与ER和PR类似,40%的PPSPCs病例p53阳性表达,与之相对85%的OSPCs病例呈现p53阳性,具有显著统计学差异(p=0.045)。我们的结果显示PPSPC组中仅发现一例(10%,1/10)出现轻度的不连续的细胞膜着色(即1+),而OSPC组中发现3例(15%,3/20)HER-2(1+),在PPSPCs及OSPCs组中无HER-2过表达的病例。此外,在PPSPC与OSPC中无一例存在HER2基因扩增或基因拷贝数高度增加。结论 PPSPCs与OSPCs尽管在组织病理学、临床特点以及分子生物学特征上有相似之处,但是前者更常见于老年女性,肿瘤分化差,具有较强的侵袭性,ER和/或PR低表达,p53阳性表达也低于后者,预后不良。
Objective To explore clinicopathological features and immunohistochemical comparison of primary peritoneal and primary ovarian serous papillary carcinoma in Chinese patients. Methods Ten patients, meeting strict criteria for primary peritoneal serous papillary carcinoma (PPSPC), were matched to 20 patients with ovarian serous papillary cancer (OSPC) for stage. The clinical, histological and immunohistochemical features of 48 cases of PPSPC s and OSPCs were studied. Immunohistochemistry was used to determine the status of estrogen receptors (ER), progesterone receptors (PR), the overexpression of HER-2/neu and p53 protein. HER2 gene status were evaluated by fluorescence in situ hybridization (FISH) using PathVysionTM kit. Results Patients affected with peritoneal cancer were on average 8.3 years older than those diagnosed with ovarian carcinomas (p=0.045). Of the PPSPCs, 60% were poorly differentiated, as were 25% of the OSPCs (p=0.045). Positive immunostaining for ER and PR was less in PPSPCs (60% and 10%, respectively) than OSPCs (95% and50%; p=0.031 and p=0.032, respectively). Overexpression of p53 was found in 40% of the PPSPCs and 85% of the OSPCs, and it was statistically significant (p =0.045). HER-2/neu was faint/barely perceptible membrane staining (1+) in 10% of the PPSPC versus 15% of the OSPCs. In addition, none of cases in PPSPCs and OSPCs showed HER2 amplification. Conclusions Although there were some similarities in clinical, histological and molecular biology between PPSPCs and OSPCs, the former is more common in older women, and more poorly differentiated with a strong aggressive. PPSPCs showed the low expression of ER and / or PR, and were lower expression than OSPCs, suggesting a poor prognosis.

关键词(KeyWords): |原发性腹膜浆液性乳头状腺癌|卵巢浆液性乳头状腺癌|临床病理|免疫组化|荧光原位杂交|

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作者(Author): 曾瑄;高洁;梁智勇;张静

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