摘要目的 观察卵巢浆液性上皮肿瘤中输卵管上皮的病理形态学改变,进一步探讨输卵管上皮病变与卵巢浆液性癌发生机制间的关系.方法 对79例卵巢高级别浆液性癌、12例卵巢低级别浆液性癌、16例卵巢交界性浆液性肿瘤、11例卵巢非肿瘤病例的输卵管按照广泛逐层切取检查法取材和切片,并用免疫组织化学EnVision法检测输卵管上皮p53和bcl-2的表达情况,观察输卵管分泌型上皮细胞过度生长(SCOUT)、p53印记、输卵管浆液性上皮内癌(STIC)和浸润性浆液性癌的发生情况.结果 高级别浆液性癌组、低级别浆液性癌组、交界性肿瘤组、良性对照组的输卵管上皮中均可见SCOUT,其出现率分别为60.8％(48/79)、4/12、3/16和2/11(P=0.001);而p53印记、STIC和浸润性癌仅出现在高级别浆液性癌组的输卵管上皮中,其发生率分别为29.1％(23/79)、15.2％(12/79)和44.3％(35/79).23例存在p53印记的病例中17例观察到1个病灶,6例观察到≥2个病灶,总计发现33个p53印记病灶,位于输卵管伞端22个,位于壶腹部11个,免疫组织化学标记bcl-2的阳性表达率为90.9％(30/33);12例出现STIC的病例中7例观察到1个病灶,5例发现≥2个病灶,总计18个STIC病灶,位于伞端16个,位于壶腹部2个,18个病灶全部表达bcl-2.结论 卵巢浆液性上皮肿瘤及卵巢非肿瘤病例的输卵管中均可见SCOUT,但更多见于高级别癌,p53印记、STIC和浸润性癌仅见于高级别浆液性癌病例的输卵管上皮,且主要位于伞端,表明输卵管上皮的SCOUT、p53印记、STIC和浸润性癌与卵巢高级别浆液性癌的发生有一定关系,bcl-2和p53免疫组织化学染色对于识别这些输卵管病变有帮助.

abstractsObjectives To study the morphologic changes of fallopian tubal epithelium in patients with ovarian serous epithelial tumors and to explore the relationship between the tubal epithelial changes and tumorigenesis of serous ovarian carcinoma.Methods The fallopian tubes in 79 cases of high-grade serous ovarian carcinoma,12 cases of low-grade serous ovarian carcinoma,16 cases of serous borderline ovarian tumor and 11 cases of non-ovarian benign tumors were serially examined under light microscope.Immunohistochemical study with EnVision method was used to detect the expression of p53 and bcl-2 protein in the fallopian tubal epithelium in all cases.The occurrences of secretory cell outgrowth(SCOUT),p53 signature,serous tubal intraepithelial carcinoma(STIC) and serous invasive carcinoma were analyzed.Results SCOUT in tubal epithelium was observed in 60.8％(48/79) of the high-grade serous carcinoma group,4/12 of the low-grade serous carcinoma group,3/16 of the serous borderline tumor group and 2/11 of the non-ovarian benign tumor group(P =0.001).P53 signature,STIC and serous invasive carcinoma occurred only in the fallopian tubal epithelium of patients with high-grade serous ovarian carcinoma,with the positive rates being 29.1％(23/79),15.2％(12/79) and 44.3％(35/79),respectively.Of the 23 cases with p53 signature,17 cases had solitary lesion and 6 cases involved more than two sites.A total of 33 p53 signature positive foci were found,with 22 foci located at fimbria and 11 at ampulla.Bcl-2 expression was demonstrated in 90.9％ of those foci(30/33).Of the 12 patients with STIC,7 cases were solitary and 5 cases involved more than two sites.A total of 18 STIC foci were found,with 16 foci located at fimbria and 2 at ampulla.All of them were positive for bcl-2.Conclusions SCOUT is found in fallopian tubal epithelium in patients with serous ovarian epithelial tumors,especially high-grade serious carcinoma.On the other hand,p53 signature,STIC and invasive serous carcinoma of tubal epithelium are observed only in patients with high-grade serous ovarian carcinoma,with a predilection of fimbrial involvement.Correlation exists between SCOUT,p53 signature,STIC and high-grade serous ovarian carcinomas.Bcl-2 and p53 immunostaining is helpful for demonstrating such lesions.