UPSC1例 - 华夏病理网论坛

abin 离线: 帖子：7416; 粉蓝豆：6014; 经验：11787; 注册时间：2006-10-08; 加关注 | 发消息

楼主发表于 2006-12-08 22:10|举报|关注(1)
浏览排序[ 顺序逆序楼主支持精彩 ] 快捷回复

姓名：	患者	性别：	女	年龄：	67
标本名称：	宫腔内肿瘤
简要病史：	绝经20年,阴道出血
肉眼检查：	宫腔内小乳头状肿块,切面未见明显肌层浸润

1 2 3 4
5 6 7 8
9 10 11 12
13 14 15 16
17 18 19 20
图1为全貌。图2－7显示浅肌层。图7－10显示深肌层。图11－14显示近浆膜面肌层。图15为图3的局部放大。图16为图5和图6的局部放大。图17为图7的局部放大。图18为图12的局部放大。图19为图11的局部放大。

图1
图2
图3
图4
图5
图6
图7
图8
图9
图10
图11
图12
图13
图14
图15
图16
图17
图18
图19
图20

标签：子宫乳头状浆液性癌 UPSC

本帖最后由于 2006-12-15 12:33:00 编辑

0

华夏病理/粉蓝医疗

为基层医院病理科提供全面解决方案，

努力让人人享有便捷准确可靠的病理诊断服务。

相关帖子

×参考诊断

子宫浆液性乳头状腺癌

abin 离线: 帖子：7416; 粉蓝豆：6014; 经验：11787; 注册时间：2006-10-08; 加关注 | 发消息

21 楼发表于2007-03-30 18:03:00举报|引用
返回顶部 | 快捷回复

本帖最后由于 2007-05-09 22:34:00 编辑

Occurrence of Endometrial Glandular Dysplasia Precedes
Uterine Papillary Serous Carcinoma

Wenxin Zheng, M.D., Sharon X. Liang, M.D., Ph.D., Xiaofang Yi, M.D., Ph.D.,
E. Cagnur Ulukus, M.D., John R. Davis, M.D., and Setsuko K. Chambers, M.D.

Int J Gynecol Pathol, Vol. 26, No. 1, January 2007

Summary: Endometrial glandular dysplasia (EmGD) is a newly defined entity that is commonly and specifically associated with serous endometrial intraepithelial carcinoma and uterine papillary serous carcinoma (UPSC). Endometrial glandular dysplasia has been proposed as a true precancerous lesion of UPSC based on our recent studies showing morphological and molecular linkages between these 2 lesions. The present report is to examine if EmGD occurs before UPSC development and to define the period from the occurrence of EmGD to a full-blown UPSC by studying their clinicopathologic features in a retrospective setting. A total of 250 UPSC and 258 benign cases were used as initial study source. To identify if EmGD existed before the development of UPSC, we blindly reviewed all available endometrial biopsies from a period of 3 months or earlier before hysterectomies. These included an available pool of 27 biopsy specimens from UPSC group and 29 samples from benign control group. Any endometrial abnormalities, which morphologically qualified as EmGD as defined previously in preceding biopsies were recorded. Among all endometrial biopsies before hysterectomies, we morphologically identified a total of 10 EmGD cases; 9 (33%) of 27 were from UPSC group and 1 (3.5%) of 29 were from benign control group. All 10 morphologically diagnosed EmGD cases showed a high p53 staining score (Q5) except 1 noncontributory from UPSC group and 1 from the benign control group with a score of 0. A high MIB-1 index score was seen in all EmGD cases, whereas low index was found in morphologically benign biopsies. The main purpose of this study is to report these retrospectively identified EmGD cases. The period from identifying EmGD to the presence of either a serous endometrial intraepithelial carcinoma or a full-blown UPSC ranged from 16 to 98 months with an average of 33 months.We conclude that occurrence of EmGD precedes the development of UPSC. The findings support our recently proposed UPSC development model, in which EmGD is likely to be a precursor lesion of UPSC. Further studies are needed to address issues in regard to molecular and cellular mechanisms, reversibility, risk of UPSC development, and clinical management of EmGD. Key Words: Endometrial glandular dysplasia (EmGD)—Serous endometrial intraepithelial carcinoma—Uterine papillary serous carcinoma—Endometrial cancer precursors.
很抱歉由于版权问题，不能引用全文。以下各图均引自此文，谨向郑文新老师（Wenxin Zheng, M.D.）致谢！感谢wangzhen_01提供资料！

zhjjwf 译：

子宫内膜腺体不典型增生先于子宫浆液性乳头状癌的出现

摘要：子宫内膜腺体不典型增生(EmGD)是一个新的概念体系，它通常与浆液性子宫内膜上皮内癌和子宫内膜浆液性乳头状癌(UPSC)有特定的联系.有人建议将子宫内膜腺体不典型增生看作UPSC的一种真正的癌前病变，根据我们最近的研究显示两者在形态学和分子水平有关联。本研究应用回顾性研究方式，通过观察它们的临床病理特征，以检测是否EmGD出现在UPSC发展之前，并界定从EmGD的出现到充分发展为UPSC的时期。250例UPSC 和258例良性病例被用于本次研究。为了鉴定是否EmGD 出现在UPSC 之前，我们重新观察了所有可得到的子宫切除前3个月或更早的子宫内膜活检标本。这包括来自UPSC的27例活检标本和29例良性对照组的标本。那些在子宫内膜形态学上异常，与原来活检时的诊断一致且符合EmGD的病例，将被记录下来。在所有子宫切除前的内膜活检标本中，我们在形态学上确诊为EmGD的共10例；包括27例UPSC组中的9例（33%）,29例良性对照组中的1例。除1例来自UPSC组未进行检测和1例来自良性对照组的得分为0分外，10例形态学上诊断为EmGD的病例均显示p53染色的高得分（5分）。

所有EmGD病例均表现为高MIB-1指数，但形态上表现为良性的病例则为低的MIB-1指数。本研究的主要目的是回顾性地研究这些确诊为EmGD的病例。从确诊为EmGD到出现子宫内膜上皮内浆液性癌或完全发展为UPSC的时间为16到98个月，平均为33个月。我们得出结论，EmGD的出现早于UPSC的发生。这一发现支持了我们最近提出的UPSC发展模型建议，这一模型认为EmGD很可能是UPSC的癌前病变。更深入的研究需要集中探讨其分子及细胞学机制、可逆性和UPSC发展的危害和EmGD的临床处理。

关键词：子宫内膜腺体不典型增生(EmGD) 子宫内膜上皮内浆液性癌子宫内膜浆液性乳头状癌子宫内膜癌前病变

Occurrence of Endometrial Glandular Dysplasia Precedes
Uterine Papillary Serous Carcinoma

Wenxin Zheng, M.D., Sharon X. Liang, M.D., Ph.D., Xiaofang Yi, M.D., Ph.D.,
E. Cagnur Ulukus, M.D., John R. Davis, M.D., and Setsuko K. Chambers, M.D.

Int J Gynecol Pathol, Vol. 26, No. 1, January 2007

Summary: Endometrial glandular dysplasia (EmGD) is a newly defined entity that is commonly and specifically associated with serous endometrial intraepithelial carcinoma and uterine papillary serous carcinoma (UPSC). Endometrial glandular dysplasia has been proposed as a true precancerous lesion of UPSC based on our recent studies showing morphological and molecular linkages between these 2 lesions. The present report is to examine if EmGD occurs before UPSC development and to define the period from the occurrence of EmGD to a full-blown UPSC by studying their clinicopathologic features in a retrospective setting. A total of 250 UPSC and 258 benign cases were used as initial study source. To identify if EmGD existed before the development of UPSC, we blindly reviewed all available endometrial biopsies from a period of 3 months or earlier before hysterectomies. These included an available pool of 27 biopsy specimens from UPSC group and 29 samples from benign control group. Any endometrial abnormalities, which morphologically qualified as EmGD as defined previously in preceding biopsies were recorded. Among all endometrial biopsies before hysterectomies, we morphologically identified a total of 10 EmGD cases; 9 (33%) of 27 were from UPSC group and 1 (3.5%) of 29 were from benign control group. All 10 morphologically diagnosed EmGD cases showed a high p53 staining score (Q5) except 1 noncontributory from UPSC group and 1 from the benign control group with a score of 0. A high MIB-1 index score was seen in all EmGD cases, whereas low index was found in morphologically benign biopsies. The main purpose of this study is to report these retrospectively identified EmGD cases. The period from identifying EmGD to the presence of either a serous endometrial intraepithelial carcinoma or a full-blown UPSC ranged from 16 to 98 months with an average of 33 months.We conclude that occurrence of EmGD precedes the development of UPSC. The findings support our recently proposed UPSC development model, in which EmGD is likely to be a precursor lesion of UPSC. Further studies are needed to address issues in regard to molecular and cellular mechanisms, reversibility, risk of UPSC development, and clinical management of EmGD. Key Words: Endometrial glandular dysplasia (EmGD)—Serous endometrial intraepithelial carcinoma—Uterine papillary serous carcinoma—Endometrial cancer precursors.
很抱歉由于版权问题，不能引用全文。以下各图均引自此文，谨向郑文新老师（Wenxin Zheng, M.D.）致谢！感谢wangzhen_01提供资料！

zhjjwf 译：

子宫内膜腺体不典型增生先于子宫浆液性乳头状癌的出现

摘要：子宫内膜腺体不典型增生(EmGD)是一个新的概念体系，它通常与浆液性子宫内膜上皮内癌和子宫内膜浆液性乳头状癌(UPSC)有特定的联系.有人建议将子宫内膜腺体不典型增生看作UPSC的一种真正的癌前病变，根据我们最近的研究显示两者在形态学和分子水平有关联。本研究应用回顾性研究方式，通过观察它们的临床病理特征，以检测是否EmGD出现在UPSC发展之前，并界定从EmGD的出现到充分发展为UPSC的时期。250例UPSC 和258例良性病例被用于本次研究。为了鉴定是否EmGD 出现在UPSC 之前，我们重新观察了所有可得到的子宫切除前3个月或更早的子宫内膜活检标本。这包括来自UPSC的27例活检标本和29例良性对照组的标本。那些在子宫内膜形态学上异常，与原来活检时的诊断一致且符合EmGD的病例，将被记录下来。在所有子宫切除前的内膜活检标本中，我们在形态学上确诊为EmGD的共10例；包括27例UPSC组中的9例（33%）,29例良性对照组中的1例。除1例来自UPSC组未进行检测和1例来自良性对照组的得分为0分外，10例形态学上诊断为EmGD的病例均显示p53染色的高得分（5分）。

所有EmGD病例均表现为高MIB-1指数，但形态上表现为良性的病例则为低的MIB-1指数。本研究的主要目的是回顾性地研究这些确诊为EmGD的病例。从确诊为EmGD到出现子宫内膜上皮内浆液性癌或完全发展为UPSC的时间为16到98个月，平均为33个月。我们得出结论，EmGD的出现早于UPSC的发生。这一发现支持了我们最近提出的UPSC发展模型建议，这一模型认为EmGD很可能是UPSC的癌前病变。更深入的研究需要集中探讨其分子及细胞学机制、可逆性和UPSC发展的危害和EmGD的临床处理。

关键词：子宫内膜腺体不典型增生(EmGD) 子宫内膜上皮内浆液性癌子宫内膜浆液性乳头状癌子宫内膜癌前病变

0

华夏病理/粉蓝医疗

为基层医院病理科提供全面解决方案，

努力让人人享有便捷准确可靠的病理诊断服务。

zhongshihua 离线: 帖子：1608; 粉蓝豆：0; 经验：1651; 注册时间：2006-09-11; 加关注 | 发消息

22 楼发表于2006-12-09 17:41:00举报|引用
返回顶部 | 快捷回复

子宫内膜癌,考虑浆液性乳头状腺癌.

0

: 宠辱不惊，闲看庭前花开花落；去留无意，漫随天外云卷云舒！

abin 离线: 帖子：7416; 粉蓝豆：6014; 经验：11787; 注册时间：2006-10-08; 加关注 | 发消息

23 楼发表于2007-05-01 22:55:00举报|引用
返回顶部 | 快捷回复

FIG. 1. Endometrial biopsy 16 months before hysterectomy in case 1. Focal areas of EmGD lining on the surface of an otherwise unremarkable endometrial polyp were seen (A, arrow). Mild-to-moderate degree of atypia of the EmGD cells was better appreciated in a high-power view (insert in the upper right corner of A). Immunohistochemistry of p53 staining (B and a magnified picture in the insert) highlighted the EmGD cells with a score of 7 (percentage 2, intensity 3, and heterogeneity 2). The resting endometrial glands within the endometrial polyp in Figure 1A were negative for p53. Subsequent hysterectomy revealed a serous EIC within the uterus. This picture of serous EIC showed a transition from an area of EmGD (C, top half of the gland) to an area of serous EIC (C, bottom half of the gland) (Original magnifications, ×40 for A and B, and ×200 for C).

图1
图2
图3

0

华夏病理/粉蓝医疗

为基层医院病理科提供全面解决方案，

努力让人人享有便捷准确可靠的病理诊断服务。

abin 离线: 帖子：7416; 粉蓝豆：6014; 经验：11787; 注册时间：2006-10-08; 加关注 | 发消息

24 楼发表于2007-05-01 22:55:00举报|引用
返回顶部 | 快捷回复

FIG. 2. Endometrial glandular dysplasia glands in an endometrial polyp of case 2. The endometrial biopsy was performed 17 months before the hysterectomy. Figure 2A was the H&E of the biopsy showing areas of EmGD. Although dysplastic features of the EmGD cells were subtle (a small rectangular box), they were appreciated under a high-power view (insert in the upper right corner of Fig. 2A). Figure 2B demonstrated a positive p53 stain with a score of 6. This is a relatively classic picture of p53 pattern in an EmGD lesion. Subsequent hysterectomy with staging showed an UPSC (C) and a mixed clear cell and serous carcinoma of the ovary (D) (original magnifications, ×200 for A and B and ×100 for C and D).

图1
图2
图3
图4

0

华夏病理/粉蓝医疗

为基层医院病理科提供全面解决方案，

努力让人人享有便捷准确可靠的病理诊断服务。

abin 离线: 帖子：7416; 粉蓝豆：6014; 经验：11787; 注册时间：2006-10-08; 加关注 | 发消息

25 楼发表于2007-05-01 22:57:00举报|引用
返回顶部 | 快捷回复

FIG. 3. Endometrial glandular dysplasia glands on the surface of atrophic endometrium in case 3. The endometrial biopsy sample showed several strips of atrophic endometrium. One piece of the atrophic endometrium contained 2 foci of EmGD with 1 on the surface (A with arrow). One piece of them showed 2 foci of EmGD with 1 on the surface (A with arrow) and the other showed 2 small papillary fronds (in the center of Fig. 3A). Mild-tomoderate degree of cytological atypia of these 2 foci of EmGD could be better appreciated in Panel C (from magnified arrowed area of Fig. 3A) and a high-power view (insert in the right low corner of Fig. 3A), respectively. The p53 immunostain for the surface EmGD had a score of 6 (D). Unfortunately, the papillary area was lost in the p53 stained slide. Figure 3B showed a carcinosarcoma in the hysterectomy specimen, which was performed 98 months after the previous endometrial biopsy. The carcinoma component showed serous type malignant cells, whereas sarcomatous component was homologous type. A mitotic figure was seen in a high-power view (insert in the upper right corner of Fig. 3B) (original magnifications, ×100 for A and B and ×200 for C and D).

图1
图2
图3
图4

0

华夏病理/粉蓝医疗

为基层医院病理科提供全面解决方案，

努力让人人享有便捷准确可靠的病理诊断服务。

abin 离线: 帖子：7416; 粉蓝豆：6014; 经验：11787; 注册时间：2006-10-08; 加关注 | 发消息

26 楼发表于2007-05-01 22:57:00举报|引用
返回顶部 | 快捷回复

FIG. 4. The endometrial biopsy of case 4 performed 21 months before the hysterectomy. Figure 4A showed one of several clusters of EmGD lesion, which was cytologically atypical with mild-to-moderate degree of nuclear pleomorphism, focally increased nuclear size, and hyperchromasia. Subsequent p53 staining was positive with a score of 5 (B). The intensity of the stain correlates with the degree of nuclear atypia and is usually more intense in the cells with a higher nuclear atypicality. Background of resting endometrial cells was negative for p53 staining. A 20% MIB-1 labeling index for this focus of EmGD was not shown (original magnifications, ×200).

图1
图2

0

华夏病理/粉蓝医疗

为基层医院病理科提供全面解决方案，

努力让人人享有便捷准确可靠的病理诊断服务。

abin 离线: 帖子：7416; 粉蓝豆：6014; 经验：11787; 注册时间：2006-10-08; 加关注 | 发消息

27 楼发表于2007-05-01 22:58:00举报|引用
返回顶部 | 快捷回复

本帖最后由于 2007-05-01 23:02:00 编辑

FIG. 5. Case 5 with EmGD lesions in an endometrial biopsy 16 months before the hysterectomy. The specimen showed several fragments of endometrial polyp (A). There was 1 small fragment of the endometrium (arrow in A) showing atypical cells with a relatively large amount of eosinophilic cytoplasm (magnified view in Fig. 5C). The degree of nuclear atypia in this endometrial fragment falls short of serous EIC but meets the criteria of EmGD diagnosis. Subsequent p53 staining showed that the atypical cells were positive with a score of 6 (B and D). The patient had a serous EIC with extrauterine serous carcinoma in the uterus and in staged specimens, which were not shown here (original magnifications, ×40 for A and B and ×400 for C and D).

图1
图2
图3
图4

0

华夏病理/粉蓝医疗

为基层医院病理科提供全面解决方案，

努力让人人享有便捷准确可靠的病理诊断服务。

abin 离线: 帖子：7416; 粉蓝豆：6014; 经验：11787; 注册时间：2006-10-08; 加关注 | 发消息

28 楼发表于2007-05-01 22:58:00举报|引用
返回顶部 | 快捷回复

FIG. 6. Endometrial glandular dysplasia lesion in an endometrial biopsy specimen 26 months before the hysterectomy from case 6. The lesion was indicated by an arrow in Figure 6A and further demonstrated in an intermediate power as in Figure 6B. There were 2 separate foci in the field (circle and arrow in Fig. 6B), which were viewed at higher magnifications in separate pictures (circle in Fig. 6C and arrow in Fig. 6D). An example of EmGD from the area with arrow was positive for p53 nuclear staining with a score of 7 (E). Panel F showed 35% MIB-1 staining index in a subsequent level of the endometrial biopsy. The hysterectomy findings were not shown (original magnifications, ×40 for A and F, ×100 for B, and ×200 for C, D, and E).