卵巢浆液性和粘液性交界瘤的临床病理分析

目的：观察卵巢交界瘤的临床病理学特点,探索肿瘤不同组织学改变的意义。方法：对45例卵巢浆液性和粘液性交界瘤进行回顾性分析,肿瘤分期按国际妇产科联合会（FIGO）标准,Ⅰ期34例,Ⅱ期4例,Ⅲ期7例。结果：45例卵巢浆液性和粘液性交界瘤占同期卵巢上皮恶性肿瘤的25．4％,浆液性同粘液性交界瘤的比为1：1．3,11例生长于卵巢表面的浆液性交界瘤中,9例出现腹膜种植,2例为浸润性种植,7例为非浸润性种植。2例浆液性交界瘤和1例粘液性交界瘤分别于术后5、4和1年复发。33例交界瘤经2－9年随访,按Kaplan-Meier法5年生存率为100％。结论：卵巢浆液性交界瘤预后较好,卵巢表面生长的浆液性交界瘤常伴有腹膜种植。     

卵巢黏液性肿瘤中EGFR表达和K-RAS基因的突变

目的 研究卵巢黏液性肿瘤中表皮生长因子受体(epidermal growth factor receptor,EGFR)蛋白的表达及K-RAS基因的突变,探讨卵巢黏液性肿瘤的发病机制及靶基因治疗的可行性.方法 应用免疫组化PV 9000两步法和PCR-RFLP法分别检测20例卵巢黏液性囊腺瘤、40例卵巢黏液性交界性囊腺瘤和40例卵巢黏液性囊腺癌中EGFR蛋白的表达和K-RAS基因的突变情况.结果 EGFR在卵巢黏液性囊腺瘤、黏液性交界性囊腺瘤和囊腺癌中的阳性表达率分别为0、37.5%、67.5%(P<0.01).K-RAS在卵巢黏液性囊腺瘤、黏液性交界性囊腺瘤和囊腺癌中的突变率分别为0、37.5%、7.5%,交界组突变率明显高于其他2组,但卵巢囊腺瘤与囊腺癌比较,差异无统计学意义(P>0.05).EGFR与卵巢黏液性囊腺癌的临床分期、病理分级、患者年龄无关(P<0.05),与肿瘤的大小相关(P<0.05).EGFR与卵巢黏液性交界性肿瘤临床病理分期、肿瘤大小、患者年龄无关(P>0.05).K-RAS基因突变与卵巢黏液性交界性肿瘤临床病理分期、肿瘤大小无关(P>0.05),与患者年龄相关(P<0.05).EGFR的表达和K-RAS基因的突变在卵巢黏液性交界性肿瘤中无相关性(P>0.05).结论 EGFR对卵巢黏液性交界性囊腺瘤和卵巢黏液性囊腺癌的形成起到了一定的作用,而K-RAS基因则可能是卵巢黏液性交界性囊腺瘤形成的一个重要因素.     

卵巢交界性浆液性肿瘤17例临床病理分析

目的对卵巢交界性浆液性肿瘤的临床特征、病理学特点进行分析,探讨其诊断及鉴别诊断。方法收集17例卵巢交界性浆液性肿瘤患者的临床资料,对组织病理学表现进行分析,并复习相关文献。结果17例卵巢交界性浆液性肿瘤患者,年龄42~65岁,平均年龄51.2岁。17例患者中有4例患者常有下腹不适和腹胀、尿频等症状,有5例患者有经期延长与出血量多的症状,还有2例患者因肿瘤破溃导致急腹症。结论卵巢交界性浆液性肿瘤的患者,预后相当好,5年生存率为90%。但仍有10%的患者预后不好。     

腹腔镜手术治疗卵巢良性畸胎瘤

目的探讨卵巢良性畸胎瘤腹腔镜手术的适应症、方法和临床应用价值. 方法对26例卵巢良性畸胎瘤患者行腹腔镜下肿瘤剥除术或附件切除术,分析其手术适应症、术中、术后情况及近期和远期并发症. 结果 26例卵巢畸胎瘤均在腹腔镜下完成手术,单侧的23例,双侧的3例,囊肿直径3～9cm,20例行囊肿剥除术,6例行附件切除.平均手术时间110分钟,术中出血量20～100ml,病理报告全部为卵巢良性囊性畸胎瘤.术后体温2～3天恢复正常的23例,术后住院平均5.2天. 随访1～40个月,症状、妇科检查和B超检查等均未发现异常. 结论腹腔镜下手术治疗卵巢成熟畸胎瘤是一种安全、有效且可进行早期治疗的方法,具有损伤小、恢复快,并发症少等优点.     

腹腔镜手术治疗卵巢良性畸胎瘤

目的：探讨卵巢良性畸胎瘤腹腔镜手术的适应症、方法和临床应用价值。方法：对26例卵巢良性畸胎瘤患者行腹腔镜下肿瘤剥除术或附件切除术，分析其手术适应症、术中、术后情况及近期和远期并发症。结果：26例卵巢畸胎瘤均在腹腔镜下完成手术，单侧的23例，双侧的3例，囊肿直径3－9cm，20例行囊肿剥除术，6例行附件切除。平均手术时间110分钟，术中出血量20－100ml，病理报告全部为卵巢良性囊性畸胎瘤。术后体温2－3天恢复正常的23例，术后住院平均5．2天，随访1－40个月，症状、妇科检查和B超检查等均未发现异常。结论：腹腔镜下手术治疗卵巢成熟畸胎瘤是一种安全、有效且可进行早期治疗的方法，具有损伤小、恢复快，并发症少等优点。     

H3K9Ac在卵巢上皮性肿瘤中的表达及其临床意义

目的 研究组蛋白H3赖氨酸残基9位乙酰化（H3KgAc）在卵巢上皮性肿瘤中的表达及其与卵巢癌组织学分级、临床分期之间的关系。方法 采用免疫组织化学ABC法检测20例良性、16例交界性、40例恶性卵巢上皮性肿瘤中H3K9Ac的表达情况，并分析其与临床病理指标间的关系。结果 ①H3K9Ac在良性、交界性、恶性卵巢上皮性肿瘤中的表达逐渐降低，差异有显著统计学意义（P〈0．01）；②与粘液性囊腺癌相比，H3KgAc在浆液性囊腺癌中表达较低，差异有统计学意义（P〈0．05）；③H3KgAc的表达与卵巢上皮性癌的组织分化程度及临床分期有关，在Ⅲ、Ⅳ期卵巢癌中H3KgAc的表达明显低于Ⅰ、Ⅱ期卵巢癌（P〈0．01）；随着组织分化程度降低，H3KgAc表达也逐渐降低，两两比较差异有统计学意义（P〈0．05）。结论 H3KgAc在良性、交界性、恶性卵巢上皮性肿瘤中的表达差异显著，且随着卵巢上皮性癌恶性程度的增高，表达逐渐降低，H3K9Ac可能为卵巢上皮性肿瘤的良恶性及其预后判断提供一个新的生物学指标。     

卵巢交界性浆黏液性肿瘤临床病理分析

目的探讨卵巢交界性浆黏液性肿瘤的临床病理特征、诊断、鉴别诊断、治疗及预后。方法回顾性分析10例卵巢交界性浆黏液性肿瘤的临床病理资料,并复习相关文献。结果患者年龄27～59岁,平均45岁。5例肿瘤位于左侧卵巢,5例位于右侧卵巢。肿瘤最大直径5～13 cm,切面以囊性为主,囊壁内侧见大小不等的乳头状赘生物,囊内含黏液或黏稠胶冻样物。肿瘤组织主要由子宫颈管型黏液上皮及浆液性上皮组成,肿瘤细胞呈腺样、粗大球茎状或乳头状排列,轻～中度异型,核分裂象不易见,肿瘤间质内见特征性中性粒细胞浸润。6例肿瘤伴卵巢子宫内膜异位症,1例合并良性附壁结节,2例合并子宫内膜样癌。免疫表型:肿瘤细胞PAX-8、CK7、ER均呈阳性(10/10),PR阳性(7/10),CK20、CDX2均呈阴性(10/10),WT-1阴性(9/10),Ki-67增殖指数1%～10%。10例患者FIGO分期ⅠA期2例,ⅠB期1例,ⅠC1期4例,ⅠC2期1例,ⅠC3期2例。术后随访12～55个月,除1例在29个月盆腔包块复发以外,其余9例均未出现复发或转移。结论卵巢交界性浆黏液性肿瘤相对少见,具有独特的临床病理特征和免疫表型,手术切除治疗预后较好。     

Numb蛋白在卵巢浆液性肿瘤中的表达及临床意义

目的检测Numb蛋白在卵巢浆液性肿瘤组织中的表达及其临床意义。方法用免疫组织化方法检测Numb蛋白在卵巢浆液性囊腺癌、交界性浆液性囊腺瘤、浆液性囊腺瘤及正常卵巢组织中的表达情况,并与患者的临床病理资料进行分析。结果Numb蛋白在卵巢浆液性囊腺癌中表达阳性率明显低于卵巢正常组织和卵巢浆液性囊腺瘤及交界性浆液性囊腺瘤的阳性率(P0.01),但与肿瘤分化程度、临床病理分期、淋巴结转移及年龄均无明显相关性(P0.05)。结论Numb蛋白在卵巢浆液性囊腺癌中低表达,可能参与浆液性囊腺癌的发生过程。     

卵巢黏液性交界性肿瘤中K-ras基因突变及p21 ras蛋白的表达

目的：观察卵巢黏液性交界性肿瘤中K-ras基因突变及p21 ras蛋白的表达,探讨卵巢黏液性交界性肿瘤的发病机制及靶基因治疗的可能。方法采用PCR-RFLP法和免疫组化EliVision法分别检测40例卵巢黏液性交界性囊腺瘤、40例卵巢黏液性囊腺癌和20例卵巢黏液性囊腺瘤中K-ras基因突变和p21 ras蛋白的表达。结果 K-ras基因在卵巢黏液性囊腺瘤、黏液性交界性囊腺瘤和黏液性囊腺癌中的突变率分别为0、37.5%、7.5%,交界组突变率明显高于其他两组,差异有统计学意义( P<0.01)。 K-ras基因突变在卵巢黏液性交界性肿瘤年龄分组中突变,差异有统计学意义(P<0.05)。 p21ras蛋白在卵巢黏液性囊腺瘤、黏液性交界性囊腺瘤和黏液性囊腺癌中阳性率分别为5%、45%、10%,交界组阳性率明显高于其他两组,差异有统计学意义(P <0.01)。结论 K-ras基因突变及p21ras蛋白表达可能是卵巢黏液性交界性肿瘤形成的原因之一,有利于卵巢黏液性交界性肿瘤的判断,还可为临床作为靶向治疗药物分析提供病理学基础。     

卵巢浆液性肿瘤中IQGAP1与E-cadherin表达的检测

目的探讨上皮性钙黏素(E-cadherin)与具有IQ结构域的人Ras GTP激活蛋白相关蛋白1(IQGAP1)在卵巢浆液性肿瘤中的表达及其临床意义。方法分别用免疫组织化学SP法和Western blot法检测20例卵巢浆液性囊腺癌、10例卵巢交界性浆液性囊腺瘤、10例卵巢浆液性囊腺瘤以及10例正常卵巢组织中E-cadherin和IQGAP1的蛋白表达。结果 E-cadherin蛋白在浆液性囊腺瘤中表达最高,明显高于正常卵巢组织和浆液性囊腺癌组织(P0.05),其均值高于交界性囊腺癌,无统计学意义。IQGAP1在卵巢浆液性囊腺癌中表达较正常卵巢组织、良性及交界性肿瘤组织均增高(P0.05);免疫组织化学染色证实IQGAP1在浆液性囊腺癌中以胞膜表达为主,而在良性肿瘤中以胞质表达为主。结论 E-cadherin和IQGAP1在卵巢浆液性瘤高表达,可联合用于卵巢浆液性肿瘤的免疫组化诊断。     

Intraoperative consultation in gynecologic pathology

Intraoperative consultation is widely used in gynecologic surgical practice to make intraoperative diagnosis, primarily to aid the surgeon to plan the extent of surgery. This article reviews the indications, performance and interpretation, accuracy and diagnostic pitfalls in the three major areas of gynecologic malignancies where intraoperative consultations are most frequently requested: ovarian masses, endometrial carcinoma and carcinoma of the cervix. For ovarian masses intraoperative consultation is usually requested either for histologic confirmation of malignant or borderline primary ovarian tumors before proceeding with radical surgery, or to rule out malignancy at the time of surgery for presumed benign disease. The diagnosis of endometrial carcinoma is usually made preoperatively before definitive surgical treatment. Thus, intraoperative consultation is most often used to identify the subgroup of patients with features of high risk disease who have an increased risk of metastases and who will benefit from formal surgical staging. In cases of carcinoma of the cervix frozen section is most commonly used to estimate the extent of spread of known invasive carcinoma at the time of radical surgery. Despite its restrictions, frozen section diagnosis is an important and reliable tool in the clinical management of patients with ovarian, endometrial and cervical tumors. The specificity of the method in experienced hands is high, the sensitivity is sufficient. The diagnosis of borderline ovarian tumors may be troublesome however, mainly due to their heterogeneity in appearance, especially in the case of large tumors of mucinous histologic type. It is important for pathologists to have a clear idea of the role and limitations of frozen section diagnosis in gynecological surgery in order to play a meaningful and optimal role in the management of the gynecologic oncology patient.     

Analysis of ovarian borderline tumors using comparative genomic hybridization and fluorescence in situ hybridization.

It is unclear whether ovarian borderline tumors (tumors of low malignant potential) are independent entities or whether they are part of a continuum of tumor progression that culminates in ovarian carcinoma. Little is known about genetic abnormalities in borderline tumors because of the difficulty of growing them in culture for chromosome studies, and because the low ratio of tumor to nontumor cells can interfere with molecular genetic examination. To circumvent these problems, we performed comparative genomic hybridization (CGH) on 10 serous borderline tumors from nine patients, using microdissection to enrich the samples for tumor DNA and reduce contamination from stromal and inflammatory cells. CGH analysis revealed that three of the tumors had detectable chromosomal imbalances, whereas seven were in a balanced state. In those tumors with imbalances, the number of abnormalities ranged from 3-6 per tumor. Additional studies by fluorescence in situ hybridization (FISH) on disaggregated nuclei confirmed the imbalances detected by CGH, revealed one tumor to be hypertriploid, and indicated that the remaining tumors were diploid and in a balanced state. All abnormalities observed in the aneuploid cases are consistent with chromosomal aberrations previously reported for ovarian carinomas, providing further evidence that some borderline tumors are part of a continuum of tumor progression. These results also suggest that there may be different mechanisms leading to borderline tumor formation, including one associated with multiple chromosomal imbalances, and others that do not involve imbalances detectable by CGH. Genes Chromosomes Cancer 25:307-315, 1999.     

Periodical changes in diagnosis and treatment of ovarian tumors]

Malignant ovarian tumors are one of the most rapidly changing gynecological malignancies concerning diagnosis and treatment during the last 20 years. Clinical cases of about 1,000 malignant ovarian tumors including borderline malignancies enlisted in the Tokai Ovarian Cancer Study Group were analyzed for periodical improvement. A comparison between the 460 cases treated in 1974-1979 and the 574 cases treated in 1980-1985, revealed a nearly 20% improvement in the 5-year survival rate. Also another comparison was made for ovarian carcinoma according to the clinical stage. Periodical improvement was shown in all clinical stages in almost the same amount, which was about 20% or more. The 5-year death rate was compared in accordance with age of patient and histological type of the tumor. Dominant progression was observed in younger generation under forty years of age, and in serous carcinoma and yolk sac tumor. However, no progression was observed for patients in their sixties and unclassified carcinoma. Periodical changes of findings in autopsy were compared between cases autopsied in 1968 and in 1988, according to the annual paper reported by Japan Pathological Society. Number of autopsied cases for malignant ovarian tumors were increased 3 times in 1988. In 1968, nearly 60% of the malignant ovarian tumors were treated by doctors in internal medicine, surgery and radiology etc., rather than gynecology, which was partly because the primary site of the cancer was unknown during the clinical course and partly because the gynecologist gave up treatment of patients in advanced cases.(ABSTRACT TRUNCATED AT 250 WORDS)     

Ovarian atypical endometriosis: its close association with malignant epithelial tumours

The incidence of ovarian atypical endometriosis and its association with malignant epithelial tumours in a consecutive series of cases during the period 1987 to 1995 were studied. Atypical glandular changes were observed in four (1.7%) of 255 ovarian endometriosis cases and one patient with ovarian atypical endometriosis developed subsequent endometrioid carcinoma in the abdominal wall. Fifty-four (24.1%) of the 224 ovarian cancers were associated with ovarian endometriosis; 21 with typical and 33 with atypical endometriosis. Clear cell carcinomas and endometrioid carcinomas were most frequently associated with endometriosis, with 54% (27 of 50 cases) and 41.9% (13 of 31), respectively. Atypical endometriosis was found in 18 clear cell carcinomas, in seven endometrioid carcinomas, in four serous carcinomas, in three mucinous borderline tumours, and in one serous borderline tumour. In 13 cases, the atypical endometriosis was in contiguity with malignant epithelial tumours. We consider that atypical endometriosis possesses a precancerous potential or is most frequently associated with clear cell and endometrioid carcinomas. Close screening of cellular atypia or hyperplasia in ovarian endometriosis and careful long-term follow-up of patients with atypical endometriosis is required.     

HER-2/neu在卵巢上皮性肿瘤中的表达及意义

目的 研究HER－2／neu（c-erbB-2)在卵巢上皮性肿瘤中的表达及意义。方法 收集106例卵巢上皮性肿瘤（恶性54例,交界性33例,良怀19例）及临床资料。按国际妇产科联合会（FIGO）标准进行分期,卵巢癌中Ⅰ,Ⅱ期中19例（19／54,35．2％）,Ⅲ,Ⅳ期共35例（35／54,64．8％）,交界性肿瘤均为Ⅰ期。采用标记链霉素卵白素生物素（LSAB）法用HER－2／neu多克隆抗体（DAKO,A0485）行免疫组织化学染色。结果 该蛋白表达的阳性率在良性肿瘤为47．4％（9／19）,过表达（3＋）为0;交界性肿瘤为84．8％（28／33）,过表达率为9．15（3／33）,恶性肿瘤为85．2％（46／54）,过表达率为25．9％（14／54）。良性与交界性以及良性与恶性之间的HER－2／neu蛋白表达率的差异有显著性（P＜0．02,P＜0．01）;该蛋白的过表达率在有转移和无转移的病例之间差异有显著性意义（P＜0．001）。结论 HER－2／neu的过表达与卵巢癌的侵袭性生物学行为相关。     

Uncommon ovarian epithelial tumours

Epithelial ovarian tumours represent the most common type of ovarian tumour. Most of malignant cases represent high-grade serous, clear cell and endometrioid carcinomas; borderline serous and mucinous tumours of intestinal type are less common. This review focuses on the uncommon or rare epithelial tumours of the ovary which include borderline and malignant Brenner tumours, the recently-described mesonephric-like carcinoma of the ovary, and primary ovarian neuroendocrine tumours, with emphasis on helpful and diagnostic features.     

Cystosarcoma phyllodes of the breast: histologic features, flow cytometric analysis, and clinical correlations.

The histologic features of 187 cases of cystosarcoma phyllodes of the breast were reviewed. The tumors were divided into histologically benign, borderline, and malignant categories. Correlation with clinical outcome was available in 100 cases. Overall rate of local recurrence was 28% (benign, 27%; borderline, 32%; malignant, 26%). Metastases occurred in eight of 100 cases (two borderline and six malignant). Although no histologic features were predictive of local recurrence, stromal overgrowth, mitotic rate greater than 15 per 50 high-power fields, and cytologically atypical stromal cells characterized seven of the eight tumors that metastasized. These features were not evident in the eighth case. Flow cytometric analysis of eight tumors (four benign, two borderline, and two malignant) showed discordance between histology and DNA content in three cases. There was slightly better correlation of histology and S-phase fractions. Based on these results demonstrating the difficulty in predicting clinical outcome, wide local excision remains an appropriate initial method of treatment. Simple mastectomy may be necessary for very large tumors and should be considered in histologically malignant tumors and cases with multiple recurrences, since some recurrent tumors in this series showed increasingly unfavorable histologic features.     

Ovarian tumors of borderline malignancy (tumors of low malignant potential): a critical appraisal.

Before the designations borderline malignancy and low malignant potential were used, the surface epithelial-stromal tumors of the ovary were simply classified into benign and malignant categories. The introduction of the borderline category of tumors has been a great advancement in classification, because it has set apart from the general group of surface epithelial cancers a subgroup with a much better prognosis, stage-for-stage, than that of conventional ovarian carcinomas. Over the last 20 years, pathologists have learned to recognize the distinctive clinicopathologic features of serous borderline tumors as well as the adverse prognostic significance of the associated invasive peritoneal lesions, whether they may represent true implants or independent primary tumors. We have urged our surgical colleagues to search for the peritoneal lesions, and sample them meticulously, and advised our fellow oncologists not to administer adjuvant therapy to patients with noninvasive implants lacking malignant epithelial cells. There is now convincing evidence in the literature that the only fatal cases of serous borderline tumors are those associated with invasive implants, and chemotherapy is indicated only for these rare tumors. It has also been demonstrated that Stage I intestinal mucinous borderline tumors and noninvasive well-differentiated mucinous carcinomas both have an almost equally good prognosis. The current treatment for pseudomyxoma peritonei is still unsatisfactory, but we have recently learned that most of the mucinous ovarian tumors associated with pseudomyxoma peritonei are secondary to similar tumors of the appendix. In the remaining cases, however, the ovarian tumor appears to be responsible for the pseudomyxoma peritonei. Borderline tumors also exist in the endometrioid, clear cell, and Brenner surface epithelial categories, but these tumors have been too rare for clear delineation of their clinical and pathologic features. Recently, some investigators have proposed to abandon the borderline category and to return to the old benign-malignant classification system by dividing unevenly the borderline tumors into a larger group of atypical proliferative epithelial cystadenomas and a smaller category of recently described but still not well-characterized noninvasive carcinomas. In the author's opinion, such a recommendation is misleading because it ignores the possibility of rare but significant behavioral exceptions on each of these two groups of tumors. Furthermore, careful tumor staging is mandatory in both instances regardless of the type of terminology used. It is hoped that by keeping the borderline designation, knowledge on this group of ovarian tumors will continue to expand as it has been until now.     

Mutational profiles of Brenner tumors show distinctive features uncoupling urothelial carcinomas and ovarian carcinoma with transitional cell histology

Brenner tumors (BT) are rare ovarian tumors encompassing benign, borderline, and malignant variants. While the histopathology of BTs and their clinical course is well described, little is known about the underlying genetic defects. We employed targeted next generation sequencing to analyze the mutational landscape in a cohort of 23 BT cases (17 benign, 2 borderline, and 4 malignant) and 3 ovarian carcinomas with transitional cell histology (TCC). Copy number variations (CNV) were validated by fluorescence in‐situ hybridization (FISH) and quantitative PCR‐based copy number assays. Additionally, we analyzed the TERT promotor region by conventional Sanger sequencing. We identified 25 different point mutations in 23 of the analyzed genes in BTs and 10 mutations in 8 genes in TCCs. About 57% percent of mutations occurred in genes involved in cell cycle control, DNA repair, and epigenetic regulation processes. All TCC cases harbored TP53 mutations whereas all BTs were negative and none of the mutations observed in BTs were present in TCCs. CNV analysis revealed recurrent MDM2 amplifications in 3 out of 4 of the malignant BT cases with one case harboring a concomitant amplification of CCND1. No mutations were observed in the TERT promoter region in BTs and TCCs, which is mutated in about 50%‐75% of urothelial carcinoma and in 16% of ovarian clear‐cell carcinomas. In conclusion, our study highlights distinct genetic features of BTs, and detection of the triplet phenotype MDM2 amplification/TP53 wt/TERT wt may aid diagnosis of malignant BT in difficult cases. Moreover, selected genetic lesions may be clinically exploitable in a metastatic setting.     

血清中人附睾上皮分泌蛋白4的测定与卵巢上皮性肿瘤患者临床病理特征的关系

为探讨卵巢上皮性肿瘤患者血清人附睾上皮分泌蛋白4（HE4）水平的变化,以及与临床病理特征的关系,采用酶联免疫吸附试验（ELISA）检测21例良性卵巢上皮肿瘤患者、12例交界性卵巢上皮肿瘤患者和49例卵巢癌患者血清HE4水平,并分析其水平与临床病理特征的关系。卵巢癌组血清HE4水平（中位数123.00pmol/L）明显高于交界性卵巢上皮肿瘤组（中位数41.20pmol/L）和良性卵巢上皮肿瘤组（中位数32.80pmol/L）;血清HE4水平与卵巢上皮性癌患者是否绝经、年龄及有无淋巴结转移无关（P〉0.05）,而与患者的临床FIGO分期（Ⅰ＋Ⅱ、Ⅲ＋Ⅳ）、病理组织学类型及有无腹水有关（P〈0.05）,浆液性癌（中位数198.50pmol/L）和子宫内膜样癌患者的血清HE4水平（中位数139.25pmol/L）明显高于黏液性癌患者（中位数30.95pmol/L）（U值分别为17.00和2.00,P〈0.01）。血清HE4水平与卵巢上皮性癌临床病理特征密切相关,并有望成为卵巢上皮性肿瘤恶变的标志物。