子宫内膜和卵巢双原发癌二例报告

子宫内膜和卵巢双原发癌二例报告莱州市人民医院（莱州市２６１４００）刘志芳李节良宫兆松１病例报告例１．患者５５岁，因绝经３年，阴道不规则流血２个月行刮宫活检，病理诊断为子宫内膜腺癌，于１９９３年３月１６日入院。既往身体健康，孕３产３，末次月经１９９０年...     

子宫内膜和卵巢双原发癌43例临床与预后分析

目的 探讨子宫内膜和卵巢双原发癌的临床病理特点、治疗方法及其预后.方法 回顾性分析43例子宫内膜和卵巢双原发癌的临床病理资料、治疗方法、生存情况及其预后.结果 43例患者的年龄为28～73岁,中位年龄49岁.主要症状为不规则阴道出血和盆腹腔疼痛.查体发现盆腹腔肿物17例(39.5%),子宫增大12例(27.9%).所有患者均行超声检查,超声发现盆腔肿瘤29例(67.4%),子宫内膜增厚或异常回声10例(23.3%).行CT或MRI检查的25例患者中,子宫增大11例(44.0%),盆腔肿瘤13例(52.0%),1例未见异常.15例患者分段取内膜活检,病理均诊断为子宫内膜癌.行CA125检查的34例患者中,22例(64.7%)CA125值升高,中位值为500 U/ml,平均为812.9 U/ml.31例患者接受全子宫双附件、大网膜及阑尾切除术;12例患者同时接受了盆腔淋巴结清扫术.以内膜样腺癌为主的子宫内膜癌38例(88.4%),卵巢癌中内膜样腺癌或含内膜样腺癌成分的混合癌患者30例(69.8%).子宫内膜癌中,ⅠA期18例,ⅠB期20例,ⅠC期2例,ⅡA期3例;卵巢癌中,ⅠA期19例,ⅠB期4例,ⅠC期7例,Ⅱ期4例,ⅢC期9例.子宫内膜癌与卵巢癌均早期(均为Ⅰ期)患者24例,占55.8%.术后接受化疗26例(60.5%),接受化疗联合放疗12例(27.9%),单纯放射治疗1例.43例患者总的3年和5年生存率分别为87.4%和71.1%.子宫内膜与卵巢肿瘤均为内膜样腺癌患者的3年和5年生存率分别为93.8%和82.0%;子宫内膜与卵巢肿瘤不均是内膜样癌患者分别为79.7%和69.0%.子宫内膜癌与卵巢癌早期患者的3年和5年生存率分别为93.3%和93.3%,明显高于非早期患者(69.7%和36.7%,P=0.0002).患者治疗后复发15例,复发率为34.9%.单因素分析显示,CA125值升高、手术病理分期、化疗联合放疗对预后有显著影响.多因素分析显示,分期、化疗联合放疗对患者预后有显著影响.结论 子宫内膜和卵巢双原发癌患者多为早期,病理分化较好,多数患者预后较好,监测患者CA125水平的意义值得进一步研究.早期患者可行全子宫双附件和大网膜切除,但淋巴结清扫的意义尚不能肯定;晚期患者术后可行化疗联合放疗.     

子宫内膜和卵巢双原发癌的研究进展

子宫内膜和卵巢双原发癌( synchronous endometrial and ovarian carcinoma, SEOC)的概念在上世纪八十年代被 Ul-bright等[1]提出,病因及发病机制不明确.SEOC诊断困难,主要是因为病理诊断标准复杂,难以与子宫内膜癌卵巢转移( endometrial carcin...     

子宫内膜样腺癌组织中内分泌细胞及其雌、孕激素受体的研究

目的　探讨子宫内膜样腺癌组织中内分泌细胞与雌、孕激素受体的关系。方法　采用免疫组化S -P法 ,检测 5 0例子宫内膜样腺癌组织中嗜铬素A(CgA )、雌激素受体 (ER )及孕激素受体 (PR )的表达情况 ,并对CgA阳性的子宫内膜样腺癌组织分别进行CgA /ER及CgA/PR双重免疫组化染色。 结果　子宫内膜样腺癌组织中CgA阳性率为 44 .0 % (2 2 /5 0 )。ER阳性率为2 8.0 % (14 /5 0 ) ,PR阳性率为 5 0 .0 % (2 5 /5 0 )。子宫内膜样腺癌CgA阳性组与阴性组之间ER表达率无显著性差异 (P >0 .0 5 ) ,但PR表达率有显著性差异 (P <0 .0 5 )。 2 2例CgA阳性子宫内膜癌细胞中CgA /ER同时表达率为 10 .1% (2 2 1/2 2 0 8个细胞 ) ,CgA/PR同时表达率为 2 0 .1% (4 90 /2 44 0个细胞 )。结论　子宫内膜癌组织出现较多的内分泌细胞及ER、PR的缺失是肿瘤异质性的表现。内分泌细胞不仅影响肿瘤细胞的生长 ,而且可能与子宫内膜癌对激素治疗的抗性或激素治疗后的复发有关     

雌、孕激素受体在子宫内膜良恶性肿瘤组织中的表达及其意义

目的 检测分析雌激素受体(ER)、孕激素受体(PR)在子宫内膜良恶性肿瘤组织中的表达情况,探讨ER、PR与子宫内膜癌发生、发展的关系.方法 采用免疫组织化学SP法对58例子宫内膜癌、37例子宫内膜非典型增生,25例子宫内膜单纯性增生,25例正常子宫内膜标本进行ER和PR的检测.结果 ER、PR的阳性表达率在正常子宫内膜分别为24.0%、20.0%;单纯性增生52.0%、44.0%;非典型增生70.3%、64.9%;子宫内膜癌62.1%、56.8%.正常内膜到单纯型增生及非典型增生阳性表达率呈阶梯样上升,子宫内膜癌略低于非典型增生,两者均明显高于正常内膜(P＜0.05).子宫内膜癌ER、PR强阳性表达率在不同组织分级中高分化Ⅰ级53.8%、53.8%;中分化Ⅱ级27.8%、22.2%,低分化Ⅲ级7.1%、0,低分化低表达.高分化高表达,Ⅰ级与Ⅲ级差异有统计学意义(P＜0.05).ER、PR强阳性表达率在年龄≤50岁患者41.9%、38.7%,＞50岁25.9%、22.2%,≤50岁组高于＞50岁组,但差异无统计学意义.临床各分期之间差异无统计学意义(P＞0.10).结论 正常子宫内膜到非典型增生、癌变过程中出现ER、PR异常高表达.ER、PR表达高低与癌组织分化程度密切相关,可能与子宫内膜癌的发生、预后有一定关系.     

乳腺卵巢双原发癌21例临床分析

[目的]探讨乳腺与卵巢双原发癌的临床特点。[方法]分析21例乳腺卵巢双原发癌患者的发病年龄、两癌发病间隔、病理类型、分期、家庭史和生存期。[结果]21例患者的中位生存期为69个月，2、5年生存率分别为40.0%和13.3%。两癌发病间隔≥5年者7例（占33.3%）。卵巢癌的中位发病年龄为49岁，55岁前发病者占61.9%；病理类型以浆液性腺癌最常见（占72.6%），Ⅲ期71.4%，低分化者61.9%。[结论]乳腺与卵巢双原发癌的卵巢癌发病年龄比散发者早，多数为晚期，病理类型以低分化为主。手术为主要治疗手段。     

子宫内膜与卵巢双原发癌临床病理分析

目的 探讨子宫内膜与卵巢双原发癌的临床病理特点、治疗和预后。方法 回顾性分析12例子宫内膜与卵巢双原发癌,其中两个部位均为子宫内膜腺癌者8例,两个部位是两种完全不同的病理类型者4例。结果 子宫内膜与卵巢双原发癌术前诊断困难,12例均经术后病理确诊。其特点为：卵巢肿瘤体积较小,平均7cm;原发不孕比例高（40．7％）;早期居多,两部位均为I期者8例（66．7％）;病理类型以子宫内膜样癌最多见（66．7％）。所有病例均行手术和化疗,3年生存率为66．7％（8／12）。结论 子宫内膜与卵巢双原发癌是有别于原发性子宫内膜癌或卵巢癌的一种特殊类型的肿瘤,一般发现早,预后较好。     

人体常卵巢和卵巢恶性肿瘤雌激素及孕激素受体5年研究总结

用葡聚糖－活性炭单点饱和分析法测定２６１例正常卵巢组织，１４８例卵巢恶性肿瘤组织胞浆雌激素受体和孕激素受体。结果表明，正常卵巢组织ＥＲ和ＰＲ均值和阳性率均恶性卵巢肿瘤组织。卵巢恶性病变中，性腺间质类ＥＲ和ＰＲ含量均高于上皮性肿瘤，生殖细胞源性肿瘤和转移性癌，上皮性恶生瘤中，内膜样癌的ＥＲ和ＰＲ含量高于浆液性，粘液性及透明细胞癌，提示受体含量高者有用内分泌治疗的可能和推测有转好的预后，卵巢恶性肿瘤患     

免疫组织化学标记在子宫内膜间质肉瘤诊断和治疗中的价值

 目的 探讨免疫组织化学标记在子宫内膜间质肉瘤（ESS）中的表达及其在诊断和治疗中的价值。方法 用免疫组织化学EnVision二步法对15例原发及3例转移复发ESS进行CD10、SM-MHC、h-caldesmon、AE1／3、CD99、Ki-67、CD34、c-kit、ER、PR的检测，并与其病理组织形态、临床并发症、鉴别诊断及预后对照。结果 17例CD10阳性，其中13例强阳性，7例伴平滑肌分化，3例伴上皮样分化，7例伴性索样分化；ER13例阳性，PR16例阳性； Ki-67 36 %～78 %。结论 子宫内膜间质肿瘤可伴多方向分化，主要为平滑肌和性索样分化；CD10是诊断子宫间质肿瘤的特异抗体，结合组织形态及SM-MHC、h-caldesmon等标记可增加其特异性；ER、PR常规检测主要用于指导孕激素辅助治疗。     

子宫内膜和卵巢原发性双癌11例临床分析

目的：探讨子宫内膜和卵巢原发性双癌的临床病理特点、治疗及预后。方法：回顾性分析自2001年1月至2009年1月江西省妇幼保健医院肿瘤科收治的11例子宫内膜和卵巢原发性双癌病例资料。结果：11例患者中位年龄50岁,27．3％（3／11）患者未育。阴道出血为主要症状63．6％（7／11）,盆腔包块为主要体征90．9％（10／11）。所有患者均接受手术治疗,术后4例病理报告子宫内膜和卵巢为子宫内膜样腺癌,占36．36％。9例患者术后接受化疗,1例接受放疗。9位患者随访14—61个月,均存活,2例失访。结论：子宫内膜和卵巢原发性双癌较单纯子宫内膜癌或卵巢癌发病年龄早,部分患者有未育史,子宫内膜和卵巢均为子宫内膜样腺癌为最常见病理类型,手术治疗为首选治疗方案,根据患者的身体状况和病理类型辅以放疗和化疗。此病预后良好。     

子宫内膜和卵巢原发性双癌11例临床分析

目的:探讨子宫内膜和卵巢原发性双癌的临床病理特点、治疗及预后.方法: 回顾性分析自2001年1月至2009年1月江西省妇幼保健医院肿瘤科收治的11例子宫内膜和卵巢原发性双癌病例资料.结果: 11例患者中位年龄50岁,27.3%(3/11)患者未育.阴道出血为主要症状63.6%(7/11),盆腔包块为主要体征90.9%(10/11).所有患者均接受手术治疗,术后4 例病理报告子宫内膜和卵巢为子宫内膜样腺癌 ,占36.36%.9例患者术后接受化疗,1例接受放疗.9位患者随访14-61个月,均存活,2例失访.结论: 子宫内膜和卵巢原发性双癌较单纯子宫内膜癌或卵巢癌发病年龄早,部分患者有未育史,子宫内膜和卵巢均为子宫内膜样腺癌为最常见病理类型,手术治疗为首选治疗方案,根据患者的身体状况和病理类型辅以放疗和化疗.此病预后良好.     

同时性多原发大肠癌的外科治疗及预后因素分析

目的探讨同时性多原发大肠癌（SCC）的外科治疗方法及其预后因素。方法对手术治疗的66例SCC患者的临床资料进行回顾性研究,并结合随访资料进行生存分析。结果除1例首治时漏诊,其余均同期手术切除。其中根治性切除62例,姑息性切除3例;一并切除30例,分段切除35例。总的3,5,10年生存率分别为70．3％、60．0％和40．6％,其中同期根治性切除患者的3,5,10年生存率分别为76．0％、65．9％和46．4％。结论SCC的手术治疗并无固定模式,需根据肿瘤的位置、范围、间距以及患者的综合情况等决定。对于符合遗传性非息肉病性大肠癌诊断的患者应考虑全结肠或次全结肠切除术,以减少或避免异时性多原发大肠癌的发生。SCC的外科治疗效果并不比普通大肠癌差。     

Synchronous primary cancers of the endometrium and ovary： review of 43 cases

Objective:To investigate the clinicsl and pathological characteristics.treatment methods,and prognosis of synchronous primary cancer of the endometrium and ovary.Methods:The clinical data of 43 patients with synchronous primary cancer of endometrium and ovary were retrospectively reviewed.The survival was calculated by Kaplan-Meier method and compared using the log-rank test.Results:The median age of the patients at diagnosis was 49 years(range.28-73 years).The most common symptoms were abnormal vaginal bleeding(69.8%)and abdominal or pelvic pain(44.2%).Pelvic masses were found in 39.5%of the patients and enlarged corpus in 27.9%at physic examination.while pelvic masses were found in 67.4%of the 43 patients(29 cases)and thickening or abnormal endometrium in 23.3%(10 cases)during ultrasound exami-nation.Of 25 patients examined by CT/MRI.pelvic masses were found in 13 cases and enlarged uterus in 11 cases.All 15 patients who underwent endometriaI biopsies were proven to have endometrioid carcinomas.Serum CA125 level was found to be elevated in 22 of the 34 examined cases(64.7%)with median value 500 U/mL(range,39-3439 U/mL).FIGO stages of endometrial carcinomas:ⅠA 18 cases,ⅠB 20 cases.ⅠC 2 cases,and ⅡA 3 cases;Stages of ovarian cardnomas:ⅠA 19 case,ⅠB 4 cases,ⅠC 7 cases.Ⅱ 4 cases,and ⅢC 9cases.Twenty-four patients(55.8%)were in stage Ⅰ both endometrial and ovar-ian carcinomas.Thirty-one patients underwent total hysterectomy plus bilateral salpingo-oophorectomy with omentectomy and appendectomy,meanwhile,12 patients had pelvic lymph nedes dissection.Thirty-eight of the 43 patients(88.4%)had a pathologically proven endometrial adenocarcinomas.The predominant ovarian histologies were endometrioid or mixed tumors with endometrioid components(30/43,69.8%).Postoperatively,26 patients(60.5%)received adjuvant chemotherapy alone.12 had chemotherapy plus radiotherapy,only one patients had radiation alone and the remaining 4 cases received no adiuvant treatment.The 3-year and 5-year survival rates of the group were 87.4%and 71.1%respectively.The 3-year and 5-year survival rates of patients with endometriold carcinoma at both endometrial and ovarian were higher than that of those with non-endometriold or mixed histologic subtypes(93.8%,82% vs 79.7%.69%).The 3-year and 5-year survival rates of patients with earty stages disease were better than those of other patients(93.3%,93.3% vs 69.7%,36.7%).Recurrence developed in 15 patients(34.9%).It was showed by univariate analysis that lower CA125 level,early FIGO stage,and adjuvant chemotherapy plus radiotherapy significantly and positively affected the 5-year survival rate.while only eady FIGO stage and chemotherapy plus radiotherapy were revealed by multivariate analysis as independent prognostic factors.Conclusion:Syn- chronous primary cancers of the endometrium and ovary were different from either the primary endometrial or ovarian cancer,while usually it can be detected in early stage with a good prognosis.The impact of the CA125 level on prognosis needs to be further studied.Surgery treatment alone may be enough for early stage patients.Chemotherapy plus radiotherapy may benecessary for advanced patients.     

The relationship between estrogen receptors in primary and secondary breast carcinomas and in sequential primary breast carcinomas

Summary A review of over 2000 patients who had estrogen receptors (ER) assayed in the primary breast carcinoma identified 48 cases in whom a subsequent second primary breast carcinoma or concurrent or recurrent secondary tumour had been tested for ER status. The relationship between the ER in the two specimens was as follows: Of 14 concurrent primary and secondary breast carcinomas the ER concentration was the same in 11 cases; in 1 case it was significantly higher in the primary tumour, in 2 others the reverse was observed. There was no major discordance in ER status. In 14 sequential carcinomas (after an average disease free time of 21 months), 12 pairs had identical ER status. There was major discordance of ER status in 2 cases where the secondary tumours contained ER while the primary carcinoma did not. The ER concentrations in the primary and the secondary carcinomas were comparable in 8 cases, while 3 and 5 cases had significantly higher or lower concentrations respectively in the sequential secondary tumour. In 20 cases where breast cancer developed in the contralateral breast (after an average disease-free interval of 27.7 months), essential concordance of ER status was observed in 15 of 20 sequential carcinomas. In 5 patients the first carcinoma was ER – and the second ER +; in one additional patient the first carcinoma was ER± and the second ER –. The ER concentrations differed significantly in 14 of the 20 bilateral carcinomas. The literature on estrogen receptor variation in breast carcinoma was reviewed.     

Estrogen and progesterone receptors in malignant mixed mesodermal tumors of the ovary

Malignant mixed mesodermal tumors of the ovary occur in less than 1% of cases of ovarian cancer. They have a dismal prognosis and the most effective type of therapy is still not known. All cases of malignant mixed mesodermal tumor of the ovary between Jaunary 1, 1985 and May 1, 1994 operated on by the gynecologic oncology service are the subject of this report. Data were obtained from the hospital and office records of the patients. Nine patients who had their primary surgery by the gynecologic oncology service were found to have the diagnosis of malignant mixed mesodermal tumor of the ovary. Homologous tumors were found in five patients and heterologous tumors in four. Homologous tumors (mean survival 15.2 months) showed a better survival than heterologous tumors (mean survival 6.5 months; P = 0.001). An elevated estrogen receptor status was shown to correspond to longer survival (p < 0.0001). Six specimens were considered to be estrogen receptor positive and three were receptor negative. The mean survival in those patients who had a positive estrogen receptor status, 13.7 months, with a median of 7.5 months was significantly higher than those who were not positive, 6.7 months (P = 0.019) with a median of 6.25 months. All specimens were progesterone receptor negative. Malignant mixed mesodermal tumors of the ovary have a dismal prognosis, no effective therapy, and controversial prognostic indicators. Increasing estrogen receptor status appeared to correlate with longer mean survival. Larger, multi-institutional studies need to be done to determine the overall significance of these findings.     

激素受体与卵巢癌预后、发病机制及治疗的研究进展

卵巢癌作为恶性程度最高的妇科肿瘤,在肿瘤靶向治疗方面已取得了一定进展。激素疗法在乳腺癌治疗中的成功应用,使激素受体成为靶向治疗的首要研究方向。卵巢癌不同病理类型对激素的敏感性不同是激素疗法对卵巢癌治疗效果不同的根本原因。本文对卵巢癌激素受体的表达及其表达对预后的影响、发病机制的研究及临床治疗做综述。     

同时发生的原发性子宫内膜癌与卵巢癌2例报告及文献复习

目的:提高对同时发生的原发性子宫内膜癌与卵巢癌的认识。方法:结合文献复习,对2例诊断为同时发生的原发性子宫内膜癌与卵巢癌的诊断、治疗,进行分析。结果:2例患者均为绝经后,以绝经后不规则出血就诊,术前检查发现卵巢占位病变。术后病理确诊为原发性双癌。结论:子宫内膜和卵巢原发性双癌诊断上容易与II期卵巢癌和III期子宫内膜癌混淆,但两者的预后和治疗不同,所以明确区分两者是完全必要的。     

Molecular profiling identifies synchronous endometrial and ovarian cancers as metastatic endometrial cancer with favorable clinical outcome

Synchronous primary endometrial and ovarian cancers (SEOs) represent 10% of all endometrial and ovarian cancers and are assumed to develop as independent entities. We investigated the clonal relationship between endometrial and ovarian carcinomas in a large cohort classified as SEOs or metastatic disease (MD). The molecular profiles were compared to The Cancer Genome Atlas (TCGA) data to explore primary origin. Subsequently, the molecular profiles were correlated with clinical outcome. To this extent, a retrospective multicenter study was performed comparing patients with SEOs (n = 50), endometrial cancer with synchronous ovarian metastasis (n = 19) and ovarian cancer with synchronous endometrial metastasis (n = 20). Targeted next-generation sequencing was used, and a clonality index was calculated. Subsequently, cases were classified as POLE mutated, mismatch repair deficient (MMR-D), TP53-wild-type or TP53-mutated. In 92% of SEOs (46/50), the endometrial and concurrent ovarian carcinoma shared at least one somatic mutation, with a clonality index above 0.95, supporting a clonal origin. The SEO molecular profiles showed striking similarities with the TCGA endometrial carcinoma set. SEOs behaved distinctly different from metastatic disease, with a superior outcome compared to endometrial MD cases (p < 0.001) and ovarian MD cases (p < 0.001). Classification according to the TCGA identified four groups with different clinical outcomes. TP53 mutations and extra-utero-ovarian disease were independent predictors for poor clinical outcome. Concluding, SEOs were clonally related in an overwhelming majority of cases and showed a favorable prognosis. Their molecular profile implied a primary endometrial origin. TP53 mutation and extra-utero-ovarian disease were independent predictors for outcome, and may impact adjuvant systemic treatment planning.     

Expression of c-erbb-2 protein and epidermal growth factor receptor in endometrial carcinomas correlation with clinicopathologic and sex steroid receptor status

Background. The c-erbB-2 (HER-2/neu) protein is a membrane glycoprotein growth factor receptor showing molecular homology with the epidermal growth factor receptor (EGFR). In endometrial carcinomas, little is known about the relationship between the expression of c-erbB-2 protein and that of EGFR. Methods. The immunohistochemical reactivity of monoclonal antibodies against both of these proteins was examined in 34 endometrial carcinomas, and the presence or absence of correlation with the clinicopathologic features or with the immunohistochemical expression of sex steroid receptors (estrogen receptor [ER] and progesterone receptor [PR]) was analyzed. Results. Of the 34 patients, 22(64.7%) had c-erbB-2 protein-positive and EGFR-negative tumor, and 8 (23.5%) had tumor positivity for both proteins. Four patients had tumors negative for both proteins. ER or PR positivity was found in 24 (70.6%) of the 34 patients. Intense immunostaining for c-erbB-2 protein was found in 5 (14.7%) of the 34 patients but was not correlated with the stage or grade of differentiation in endometrial carcinoma. However, expression of EGFR in addition to c-erbB-2 protein was more frequently observed with advancing stage of disease and was inversely correlated with the grade of differentiation and with the expression of ER or PR of the tumor. Conclusion. The expression of EGFR, in addition to that of c-erbB-2 protein, is an important event that presumably is linked with progression or with a poorly differentiated state of endometrial carcinomas.