协和医学杂志

2012, (01) 77-83

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原发性腹膜和卵巢浆液性乳头状腺癌的临床病理
Clinicopathological Features and Immunohistochemical Comparison of Primary Peritoneal and Primary Ovarian Serous Papillary Carcinoma

张静;梁智勇;高洁;曾瑄;刘彤华;
ZHANG Jing,LIANG Zhi-yong,GAO Jie,ZENG Xuan,LIU Tong-hua Department of Pathology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China

摘要(Abstract):

目的分析比较原发于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特点。方法选取北京协和医院手术切除的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(即病变以腹膜或网膜为主,双侧卵巢结构正常,或病变仅累及卵巢表面上皮)及20例与之临床分期配对的原发性卵巢浆液性乳头状腺癌(ovarian serous papillary cancer,OSPC)的病例标本,分析PPSPC和OSPC临床病理学特点,用免疫组织化学染色法观察雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、人表皮生长因子受体2(human epidermalgrowth factor receptor2,HER2)及P53蛋白的表达;采用荧光原位杂交(fluorescence in situ hybridization,FISH)检测两组标本的HER2基因状态。结果 PPSPC患者平均发病年龄较OSPC患者大8.3岁,两组比较差异具有统计学意义(P=0.045)。PPSPC患者中60%为低分化浆液性癌,而OSPC患者中仅20%为低分化浆液性癌,两组比较差异具有统计学意义(P=0.045)。免疫组化结果显示,ER和PR在PPSPC组中的表达(分别为60%和10%)明显低于OSPC组(分别为95%和50%)(P=0.031和P=0.032)。P53蛋白在两组中的表达与ER和PR类似,40%PPSPC病例P53呈阳性表达,85%OSPC病例P53呈阳性表达,两组比较差异具有统计学意义(P=0.045)。PPSPC组中仅1例(10%,1/10)出现轻度不连续细胞膜着色(即1+),而OSPC组则有3例(15%,3/20)出现HER2(1+);PPSPC及OSPC组均无HER2过表达病例。此外,在PPSPC与OSPC组均未发现HER2基因扩增或基因拷贝数高度增加。结论 PPSPC与OSPC尽管在组织病理学、临床特点及分子生物学特征上有相似之处,但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,临床结局不良。
Objective To explore the clinicopathological features of primary peritoneal and primary ovarian serous papillary carcinoma in Chinese patients.Methods The clinical specimens were obtained from 10 patients who were confirmed to be with primary peritoneal serous papillary carcinoma(PPSPC) and from 20 otherwise-matched patients with ovarian serous papillary cancer(OSPC).The clinicopathological features of these PPSPC and OSPC cases were observed.The levels of estrogen receptors(ER),progesterone receptors(PR),human epidermalgrowth factor receptor 2(HER2)/neu and P53 protein were detected using immunohistochemical techniques.The status of HER2 gene was evaluated by fluorescence in situ hybridization(FISH) using PathVysionTM kit.Results The mean onset age was 8.3 years older among PPSPC patients than in OSPC patients(P=0.045).The proportion of poorly differentiated serous cancer was 60% among the PPSPC patients and 20% among the OSPC patients(P=0.045).Positive immunostaining for ER and PR was significantly less in PPSPC(60% and 10%,respectively) than OSPC(95% and 50%;P=0.031 and P=0.032,respectively).Positive expression of P53 was found in 40% of the PPSPC patients and 85% of the OSPC patients(P=0.045).HER2/neu was faint/barely perceptible membrane staining(1+) in 10% of the PPSPC patients versus 15% of the OSPC patients.In addition,HER2 amplification was not found in either group.Conclusions PPSPC and OSPC share some clinicohistological features;however,compared with OSPC,PPSPC is more common in older women,with relatively poorer differentiation,stronger potential of invasion,lower ER/PR expression,lower P53 protein expression,and poorer outcomes.

关键词(KeyWords): 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
peritoneal serous papillary carcinoma;ovarian serous papillary cancer;clinicopathological features;immunohistochemistry;fluorescence in situ hybridization

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作者(Author): 张静;梁智勇;高洁;曾瑄;刘彤华;
ZHANG Jing,LIANG Zhi-yong,GAO Jie,ZENG Xuan,LIU Tong-hua Department of Pathology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China

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