CAJ | 학술논문

目的探讨子宫乳头状浆液性癌的临床病理特点及其合理疗法,以提高对该病的认识.方法收集61例子宫乳头状浆液性癌,全面手术病理分期并随访4～9年,采用HE和免疫组织化学(EnVision法)染色,进行镜下观察,结合术后治疗方案和随访资料进行临床病理分析.结果 61例患者均为绝经后妇女,中位年龄68岁,临床表现为绝经后阴道流血和(或)腹部症状,或宫颈细胞学筛查发现异常等.肿瘤直径中位数7.5 cm(范围1.2～14.8 cm),FIGO分期:Ⅰ期17例(27.9%;Ⅰ A期8.2%,Ⅰ B期14.8%,Ⅰ C期4.9%),Ⅱ、Ⅲ和Ⅳ期分别占9.8%(6/61)、32.8%(20/61)和29.5%(18/61).活检和手术标本的组织学特点与卵巢高级别浆液性乳头状癌相似,以高级别核为特征,常出现复杂的分支状乳头状结构,沙砾体出现率24.6%(15/61),免疫组织化学染色示p53和Ki-67弥漫强阳性而雌激素受体(ER)和孕激素受体(PR)阴性(均为肿瘤细胞核着色).24.6%(15/61)未见子宫肌层浸润,但其中10/15有子宫外扩散,主要累及腹膜(6/15)和淋巴结转移(9/15).深肌层浸润、淋巴结转移和脉管受累为单个预后差的指标.56例接受术后辅助治疗,化疗者42例,放疗者24例,联合放/化疗10例.化疔组和未化疗组(用或不用放疗)的中位生存期分别为66.4和32.8个月.结论子宫乳头状浆液性癌有独特的临床和病理特征,分期、淋巴结状况、脉管受累和肌层浸润深度为主要预后指标.晚期患者和复发患者采用含有紫衫醇(单用或联合使用顺铂)的全身化疗方案,可延长患者生存期.
목적 탐토자궁유두상장액성암적림상병리특점급기합리요법,이제고대해병적인식.방법 수집61례자궁유두상장액성암,전면수술병리분기병수방4～9년,채용HE화면역조직화학(EnVision법)염색,진행경하관찰,결합술후치료방안화수방자료진행림상병리분석.결과 61례환자균위절경후부녀,중위년령68세,림상표현위절경후음도류혈화(혹)복부증상,혹궁경세포학사사발현이상등.종류직경중위수7.5 cm(범위1.2～14.8 cm),FIGO분기:Ⅰ기17례(27.9%;Ⅰ A기8.2%,Ⅰ B기14.8%,Ⅰ C기4.9%),Ⅱ、Ⅲ화Ⅳ기분별점9.8%(6/61)、32.8%(20/61)화29.5%(18/61).활검화수술표본적조직학특점여란소고급별장액성유두상암상사,이고급별핵위특정,상출현복잡적분지상유두상결구,사력체출현솔24.6%(15/61),면역조직화학염색시p53화Ki-67미만강양성이자격소수체(ER)화잉격소수체(PR)음성(균위종류세포핵착색).24.6%(15/61)미견자궁기층침윤,단기중10/15유자궁외확산,주요루급복막(6/15)화림파결전이(9/15).심기층침윤、림파결전이화맥관수루위단개예후차적지표.56례접수술후보조치료,화료자42례,방료자24례,연합방/화료10례.화정조화미화료조(용혹불용방료)적중위생존기분별위66.4화32.8개월.결론 자궁유두상장액성암유독특적림상화병리특정,분기、림파결상황、맥관수루화기층침윤심도위주요예후지표.만기환자화복발환자채용함유자삼순(단용혹연합사용순박)적전신화료방안,가연장환자생존기.
Objective To study the clinicopathologic features of uterine papillary serous carcinoma (UPSC) and the roles of adjuvant therapy. Methods Sixty-one cases of UPSC with operation done and followed up for a period of 4 to 9 years were enrolled into the study. The histology of slides specimens were reviewed and immunohistochemical study was performed. The follow-up and survival data were analyzed.Results All of the 61 patients were post-menopausal, with a median age of 68 years. The clinical presentations included abnormal vaginal bleeding, abdominal symptoms and abnormal Pap smears. The median size of the tumors was 7. 5 cm ( range = 1.2 to 14. 8 cm). There were 27.9% cases in FIGO stageⅠ(8.2% in stageⅠA, 14. 8% in stage ⅠBand4.9% in stage ⅠC), 9. 8% in stage Ⅱ, 32. 8% in stage Ⅲ and 29. 5% in FIGO stage Ⅳ.The histologic features were similar to those of the ovarian counterpart, with tumor cells containing the high-grade nuclei and arranged in complex papillae. Psammoma bodies were identified in 24. 6% of the cases. Immunohistochemical study showed that the tumor cells demonstrated diffuse and strong nuclear staining for p53 and Ki-67. They were negative for estrogen receptorand progesterone receptor. Fifteen of the 61 cases (24. 6% ) showed no evidence of myometrial invasion.However, ten of the 15 cases had extrauterine disease, with peritoneal (6/15) and nodal (9/15)involvement. Tumors with deep myometrial invasion, lymphovascular permeation and nodal metastasis were associated with worse prognosis by univariate analysis. Fifty-six patients received adjuvant therapy. The number of patients receiving adjuvant chemotherapy alone, adjuvant radiotherapy alone and combined adjuvant chemotherapy/radiotherapy were 42, 24 and 10, respectively. The median survivals of the chemotherapy group and non-chemotherapy group ( with or without radiotherapy) were 66. 4 months and 32. 8 months, respectively. Conclusions UPSC has distinctive clinical and pathologic features. The tumor stage, lymph node status, lymphovascular permeation and depth of myometrial invasion were important prognostic factors. Adjuvant chemotherapy for stage Ⅲ/Ⅳ tumors or recurrent UPSC may have survival benefit.