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卵巢癌的组织发生和起源研究正面临着临床和病理学的挑战。越来越多的事实发现提示,长久以来认为的高恶度浆液卵巢癌(H-PSC),可能既不来源于卵巢,也不产生于卵巢的上皮分化细胞。最近在输卵管伞部发现的早期H-PSC病变,被称为输卵管浆液原位癌(STIC),提供了研究卵巢癌早期发生的全新的概念和材料。例如,STIC的发现让我们有可能进一步研究和确定一些与浆液癌发生密切相关的分子改变,包括P53,BRCAl,HMGA2和微小RNA(microRNAs)。同时,STIC的发现又为我们提供进一步的思考和疑问:其他类型的卵巢癌(包括子宫内膜样的、透明细胞、黏液细胞和部分低恶度浆液癌)是否应重新定义。因为它们大都源于子宫内膜异位症、组织化生或输卵管分泌细胞,并非来自卵巢上皮细胞。显然,进一步的分子和细胞病理学研究将提供认识卵巢癌的钥匙。特别是发现那些与早期癌变有关的癌基因改变将有助于正确认识这种致命肿瘤的发生与分类,并提供早期监测和治疗的新途径。
Ovarian cancer, the occurrence and origin of the study is facing clinical and pathological challenges. A growing body of evidence suggests that high-grade serous ovarian cancer (H-PSC), which has long been considered, may not originate in the ovary nor in the epithelial differentiated cells of the ovary. The recent finding of early H-PSC lesions in the oviduct, known as tubal serous carcinoma in situ (STIC), provided entirely new concepts and materials for studying the early onset of ovarian cancer. For example, the discovery of STIC made it possible for us to further study and identify a number of molecular changes closely related to serous carcinogenesis, including P53, BRCA1, HMGA2 and microRNAs. At the same time, the findings of STIC provide us with further questions and questions as to whether other types of ovarian cancer, including endometrioid, clear cell, mucinous cells and some low-grade serous carcinomas should be redefined. Because they are mostly derived from endometriosis, histoplasm or fallopian tube secreting cells, not from epithelial cells of the ovary. Obviously, further molecular and cytopathological studies will provide the key to understanding ovarian cancer. In particular, the discovery of those oncogenes associated with early cancers will help to correctly understand the occurrence and classification of this deadly tumor and provide a new way of early monitoring and treatment.