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Злокачественные опухоли

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Взгляд клинического онколога. Как повлияет морфологическое исследование опухолей толстой кишки, мочеполовой системы на тактику лечения?

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Аннотация

Редкие опухоли любой локализации являются значимой проблемой как для морфолога в вопросе постановки правильного диагноза, так и для онколога в выборе терапии. Ведь ошибка в выборе лечения может быть чрезвычайно опасна для прогноза у пациента. В качестве примера можно вспомнить герминогенные опухоли, при которых при исходно правильном терапевтическом подходе наступает выздоровление пациента даже при отдаленных метастазах. Однако первоначально неверно выбранный режим химиотерапии (для лимфомы яичка, серозного рака яичников или внеорганной забрюшинной саркоме) снижает шансы выздоровления в разы. Таким образом, необходимо не только знать, какие особенности в лечении определяет диагноз редких опухолей, но и быть уверенным в работе морфолога. В данном обзоре мы сконцентрируемся не только на особенностях лечения опухолей толстой кишки, ассоциированных с наследственными синдромами, и редких опухолях мочеполовой системы, но и рассмотрим необходимость второго оценочного мнения патоморфолога для подтверждения диагноза с целью минимизации ошибки.

Об авторе

М. Ю. Федянин
ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н. Н. Блохина» Министерства здравоохранения РФ.
Россия


Список литературы

1. Hampel H, Frankel WL, Martin E, et al. Feasibility of screening for Lynch syndrome among patients with colorectal cancer. J Clin Oncol 2008; 26(35):5783–8.

2. Hampel H, Frankel WL, Martin E, et al. Screening for the Lynch syndrome (hereditary nonpolyposis colorectal cancer). N Engl J Med 2005; 352(18):1851–60.

3. Lynch HT, Lynch PM, Lanspa SJ, et al. Review of the Lynch syndrome: history, molecular genetics, screening, differential diagnosis, and medicolegal ramifications. Clin Genet 2009; 76(1):1–18.

4. Ligtenberg MJ, Kuiper RP, Chan TL, et al. Heritable somatic methylation and inactivation of MSH2 in families with Lynch syndrome due to deletion of the 3’ exons of TACSTD1. Nat Genet 2009; 41(1):112–7.

5. Lynch HT, Snyder CL, Shaw TG, et al. Milestones of Lynch syndrome: 1895-2015. Nat Rev Cancer 2015; 15(3):181–94.

6. Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group. Recommendations from the EGAPP Working Group: genetic testing strategies in newly diagnosed individuals with colorectal cancer aimed at reducing morbidity and mortality from Lynch syndrome in relatives. Genet Med 2009; 11(1):35–41.

7. Hampel H. NCCN increases the emphasis on genetic/familial high-risk assessment in colorectal cancer. J Natl Compr Canc Netw 2014; 12(5 Suppl): 829–31. Giardiello FM, Allen JI, Axilbund JE, et al. Guidelines on genetic evaluation and management of L ynch syndrome: a consensus statement by the US MultiSociety Task Force on colorectal cancer. Gastroenterology 2014; 147(2):502–26.

8. Syngal S, Brand RE, Church JM, et al. ACG clinical guideline: genetic testing and management of hereditary gastrointestinal cancer syndromes. Am J Gastroenterol 2015; 110(2):223–62, [quiz: 263].

9. Stoffel EM, Mangu PB, Gruber SB, et al, American Society of Clinical Oncology, European Society for Medical Oncology. Hereditary colorectal cancer syndromes: American Society of Clinical Oncology clinical practice guideline endorsement of the familial riskcolorectal cancer: European society for medical oncology clinical practice guidelines. J Clin Oncol 2015; 33(2):209–17.

10. Федянин М.Ю., Гладков О.А., Гордеев С.С., Рыков И В., Трякин А.А. Практические рекомендации по лекарственному лечению рака ободочной кишки и ректосигмоидного соединения // Злокачественные опухоли: Практические рекомендации RUSSCO #3s2, 2017 (том 7). С. 261–294.

11. Lynch HT, Lynch J. Lynch syndrome: genetics, natural history, genetic counseling, and prevention. J Clin Oncol 2000; 18(21 Suppl):19S–31S.

12. Mvundura M, Grosse SD, Hampel H, et al. The costeffectiveness of genetic testing strategies for Lynch syndrome among newly diagnosed patients with colorectal cancer. Genet Med 2010; 12(2):93–104.

13. Palomaki GE, McClain MR, Melillo S, et al. EGAPP supplementary evidence review: DNA testing strategies aimed at reducing morbidity and mortality from Lynch syndrome. Genet Med 2009; 11(1):42–65.

14. Kawakami H, Zaanan A, Sinicrope FA. Microsatellite instability testing and its role in the management of colorectal cancer. Curr Treat Options Oncol 2015; 16(7):30.

15. Sargent DJ, Marsoni S, Thibodeau SN, et al. Confimation of defiient mismatch repair (dMMR) as a predictive marker for lack of benefi from 5-FU based chemotherapy in stage II and III colon cancer (CC): a pooled molecular reanalysis of randomized chemotherapy trials. J Clin Oncol (Meet Abstr). 2008; 26(15 Suppl):4008.

16. Sinicrope FA, Foster NR, Thibodeau SN, et al. DNA mismatch repair status and colon cancer recurrence and survival in clinical trials of 5-florouracilbased adjuvant therapy. J Natl Cancer Inst. 2011; 103(11):863–75.

17. Цуканов Алексей Сергеевич. «Стратегия комплексного молекулярно-генетического изучения наследственных форм колоректального рака у российских пациентов», докторская диссертация, специальность 03.02.07 – генетика (медицинские науки).

18. Федянин М. Ю., Трякин А. А., Тюляндин С. А. Роль микросателлитной нестабильности при раке толстой кишки. Онкологическая колопроктология. 2012; (3):19–25.

19. Magrini R, Bhonde MR, Hanski ML, et al. Cellular effects of CPT-11 on colon carcinoma cells: dependence on p53 and hMLH1 status. Int J Cancer. 2002; 101(1):23–31.

20. Jacob S, Aguado M, Fallik D, Praz F. The role of the DNA mismatch repair system in the cytotoxicity of the topoisomerase inhibitors camptothecin and etoposide to human colorectal cancer cells. Cancer Res. 2001; 61(17):6555–62.

21. Koopman M, Kortman GA, Mekenkamp L, et al. Defiient mismatch repair system in patients with sporadic advanced colorectal cancer. Br J Cancer. 2009; 100(2):266–73.

22. Des Guetz G, Uzzan B, Nicolas P, et al. Microsatellite instability does not predict the effiacy of chemotherapy in metastatic colorectal cancer. A systematic review and meta-analysis. Anticancer Res. 2009; 29(5):1615–20.

23. Tejpar S, Bosman F, Delorenzi M, et al. Microsatellite instability (MSI) in stage II and III colon cancer treated with 5FU-LV or 5FU-LV and irinotecan (PETACC 3-EORTC 40993-SAKK 60/00 trial). ASCO Meet Abstr. 2009; 27(15S):4001.

24. Lipson EJ, Sharfman WH, Drake CG, et al. Durable cancer regression off-treatment and effective reinduction therapy with an anti- PD-1 antibody. Clin Cancer Res. 2013; 19:462–8.

25. Le DT, Uram JN, Wang H, et al. PD-1 blockade in tumors with mismatch-repair deficiency. N Engl J Med. 2015; 372:2509–20.

26. Study of Pembrolizumab (MK-3475) as Monotherapy in Participants With Previously-Treated Locally Advanced Unresectable or Metastatic Colorectal Cancer (MK-3475-164/KEYNOTE-164). Электронный ресурс: http://clinicaltrials.gov/show/ NCT02460198, дата обращения 22.09.2018, 2018.

27. Study of Pembrolizumab (MK-3475) vs Standard Therapy in Participants With Microsatellite Instability-High (MSI-H) or Mismatch Repair Deficient (dMMR) Stage IV Colorectal Carcinoma (MK-3475-177/KEYNOTE-177). Электронный ресурс: http://clinicaltrials.gov/show/NCT02563002, дата обращения 22.09.2018, 2018.

28. Evaluate the Efficacy of MEDI4736 in Immunological Subsets of Advanced Colorectal Cancer. Электронный ресурс: http://clinicaltrials.gov/show/NCT02227667, дата обращения 22.09.2018, 2018.

29. Larkin J, Hodi FS, Wolchok JD. Combined nivolumab and ipilimumab or monotherapy in untreated melanoma. N Engl J Med. 2015; 373:23–34.

30. Overman SK MJ, McDermott RS, Leach J, et al. A Study of Nivolumab and Nivolumab Plus Ipilimumab in Recurrent and Metastatic Colon Cancer (CheckMate 142). J. Clinical Oncology 2016; 34, 2016 (suppl; abstr 3501).

31. Andre T, Lonardi S, Wong M, et al. Nivolumab + ipilimumab combination in patients with DNA mismatch repair-deficient/ microsatellite instability-high (dMMR/MSI-H) metastatic colorectal cancer (mCRC): First report of the full cohort from CheckMate-142. J Clin Oncol, 36, 2018 (suppl 4S; abstr 553).

32. Overman MJ, Bergamo F, McDermott RS, et al. Nivolumab in patients with DNA mismatch repair-deficient/microsatellite instability-high (dMMR/MSI-H) metastatic colorectal cancer (mCRC): Long-term survival according to prior line of treatment from CheckMate-142. J Clin Oncol, 36, 2018 (suppl 4S; abstr 554).

33. Shlien A, Campbell BB, de Borja R, et al. Combined hereditary and somatic mutations of replication error repair genes result in rapid onset of ultrahypermutated cancers. Nat Genet. 2015; 47(3):257–62.

34. Rayner E, van Gool IC, Palles C, et al. A panoply of errors: polymerase proofreading domain mutations in cancer. Nat Rev Cancer. 2016; 16(2):71–81.

35. Grignon DJ, Ro JY, Ayala AG, et al. Primary adenocarcinoma of the urinary bladder. A clinicopathologic analysis of 72 cases. Cancer. 1991; 67:2165–72.

36. Mai KT, Yazdi HM, Perkins DG, et al. Multicentric clear cell adenocarcinoma in the urinary bladder and the urethral diverticulum: evidence of origin of clear cell adenocarcinoma of the female lower urinary tract from Mullerian duct remnants. Histopathology. 2000; 36:380–2.

37. Zaghloul MS, Nouh A, Nazmy M, et al. Long-term results of primary adenocarcinoma of the urinary bladder: a report on 192 patients. Urol Oncol. 2006; 24:13–20.

38. Zaghloul MS, Abdel Aziz S. Primary adenocarcinoma of the urinary bladder: risk factors and value of postoperative radiotherapy. J Egypt Natl Canc Inst. 2003; 15:193–200.

39. Sheldon CA, Clayman RV, Gonzalez R, et al. Malignant urachal lesions. J Urol. 1984; 131:1–8.

40. Ashley RA, Inman BA, Sebo TJ, et al. Urachal carcinoma: clinicopathologic features and long-term outcomes of an aggressive malignancy. Cancer. 2006; 107:712–20.

41. Bruins HM, Visser O, Ploeg M, et al. The clinical epidemiology of urachal carcinoma: results of a large, population based study. J Urol. 2012; 188:1102–7.

42. Herr HW, Bochner BH, Sharp D, et al. Urachal carcinoma: contemporary surgical outcomes. J Urol. 2007; 178:74–8. discussion 78.

43. Siefker-Radtke AO, Gee J, Shen Y, et al. Multimodality management of urachal carcinoma: the M. D. Anderson Cancer Center experience. J Urol. 2003; 169:1295–8.

44. Molina JR, Quevedo JF, Furth AF, et al. Predictors of survival from urachal cancer: a Mayo Clinic study of 49 cases. Cancer. 2007; 110:2434–40.

45. Galsky MD, Iasonos A, Mironov S, et al. Prospective trial of ifosfamide, paclitaxel, and cisplatin in patients with advanced nontransitional cell carcinoma of the urothelial tract. Urology. 2007; 69:255–9.

46. Yanagihara Y, Tanji N, Miura N, et al. Modifi ed FOLFOX6 chemotherapy in patients with metastatic urachal cancer. Chemotherapy. 2013; 59:402–6.

47. Kojima Y, Yamada Y, Kamisawa H, et al. Complete response of a recurrent advanced urachal carcinoma treated by S-1/cisplatin combination chemotherapy. Int J Urol. 2006; 13:1123–5.

48. Kume H, Tomita K, Takahashi S, et al. Irinotecan as a new agent for urachal cancer. Urol Int. 2006; 76:281–2.

49. Sirintrapun SJ, Ward M, Woo J, et al. High-stage urachal adenocarcinoma can be associated with microsatellite instability and KRAS mutations. Hum Pathol. 2014; 45:327–30.

50. Sen SE, Malek RS, Farrow GM, Lieber MM. Sarcoma and carcinosarcoma of the bladder in adults. J Urol. 1985; 133(1):29–30.

51. Russo P. Urologic sarcoma in adults. Memorial Sloan-Kettering Cancer Center experience based on a prospective database between 1982 and 1989. Urol Clin N Am. 1991; 18(3):581–8.

52. Rosser CJ, Slaton JW, Izawa JI, et al. Clinical presentation and outcome of high-grade urinary bladder leiomyosarcoma in adults. Urology. 2003; 61:1151–5.

53. Wick MR, Swanson PE. Carcinosarcomas: current perspectives and an historical review of nosological concepts. Semin Diagn Pathol. 1993; 10(2):118–27.

54. Spiess PE, Tuziak T, Tibbs RF, et al. Pseudosarcomatous and sarcomatous proliferations of the bladder. Hum Pathol. 2007; 38(5):753–61.

55. Cheng L, Zhang S, Alexander R, et al. Sarcomatoid carcinoma of the urinary bladder: the final common pathway of urothelial carcinoma dedifferentiation. Am J Surg Pathol. 2011; 35(5):e34–46.

56. Torenbeek R, Blomjous CE, de Bruin PC, et al. Sarcomatoid carcinoma of the urinary bladder. Clinicopathologic analysis of 18 cases with immunohistochemical and electron microscopic findings. Am J Surg Pathol. 1994; 18(3):241–9.

57. Wright JL, Black PC, Brown GA, et al. Differences in survival among patients with sarcomatoid carcinoma, carcinosarcoma and urothelial carcinoma of the bladder. J Urol. 2007; 178(6):2302–6.

58. Wang J, Wang FW, Lagrange CA, et al. Clinical features of sarcomatoid carcinoma (carcinosarcoma) of the urinary bladder: analysis of 221 cases. Sarcoma. 2010. pii: 454792. doi: 10.1155/2010/454792.

59. Black PC, Brown GA, Dinney CP. The impact of variant histology on the outcome of bladder cancer treated with curative intent. Urol Oncol. 2009; 27(1):3–7.

60. Thompson L, Chang B, Barsky SH. Monoclonal origins of malignant mixed tumors (carcinosarcomas). Evidence for a divergent histogenesis. Am J Surg Pathol. 1996; 20(3):277–85.

61. McCluggage WG. Malignant biphasic uterine tumours: carcinosarcomas or metaplastic carcinomas? J Clin Pathol. 2002; 55(5):321–5.

62. Damiano R, D’Armiento M, Cantiello F, et al. Gemcitabine and cisplatin following surgical treatment of urinary bladder carcinosarcoma. Tumori. 2004; 90(5):458–60.

63. Baseskioglu B, Duman BB, Kara IO, et al. Early detection and gemcitabine/cisplatin combination positively effect survival in sarcomatoid carcinoma of the urinary bladder. Asian Pac J Cancer Prev. 2012; 13(11):5729–33.

64. Paniz-Mondolfi A, Singh R, Jour G, et al. Cutaneous carcinosarcoma: further insights into its mutational landscape through massive parallel genome sequencing. Virchows Arch. 2014; 465(3):339–50.

65. Velcheti V, Rimm DL, Schalper KA. Sarcomatoid lung carcinomas show high levels of programmed death ligand-1 (PD-L1). J Thorac Oncol. 2013; 8(6):803–5.

66. Lou Y, Diao L, Byers LV, et al. Association of epithelial-mesenchymal transition status with PD1/PDL1 expression and a distinct immunophenotype in non-small cell lung cancer: implications for immunotherapy biomarkers. J Clin Oncol. 2014; 32:5s (suppl; abstr 3018).

67. Coffin C.M., Watterson J., Priest J.R., Dehner P. Extrapulmonary inflammatory myofibroblastic tumor (inflammatory pseudotumor): a clinicopathologic and immunohistochemical study of 84 cases. Am. J. Surg. Pathol. 1995; 19:859–872.

68. Coffin C.M., Hawkins A.L., Perkins S., Elenitoba-Johnson K.S., Perlman E., Griffin C.A. ALK1 and p80 expression and chromosomal rearrangements involving 2p23 in inflammatory myofibroblastic tumor. Mod. Pathol. 2001; 14:569–576.

69. Butrynski J.E., D’Adamo D.R., Hornick J.L., Dal Clin P., Antonescu C.R., Jhanwar S.C. Crizotinib in ALK-rearranged inflammatory myofibroblastic tumor. N. Engl. J. Med. 2010; 363:1727–1733.

70. Kronz JD, Westra WH, Epstein JI. Mandatory second opinion surgical pathology at a large referral hospital. Cancer. 1999 Dec 1; 86(11):2426-35.

71. Santoso JT, Coleman RL, Voet RL, et al. Pathology slide review in gynecologic oncology. Obstet Gynecol 1998; 91:730 – 4.

72. Selman AE, Niemann TH, Fowler JM, Copeland LJ. Quality assurance of second opinion pathology in gynecologic oncology. Obstet Gynecol. 1999 Aug; 94(2):302-6.

73. Chan YM, Cheung AN, Cheng DK, et al. Pathology slide review in gynecologic oncology: routine or selective? Gynecol Oncol 1999; 75:267–71.

74. Abt LG, Olt GJ. The effect of interinstitution anatomic pathology consultation on patient care. Arch Pathol Lab Med 1995; 119:514–7.

75. Epstein JI, Walsh PC, Sanfilippo F. Clinical and cost impact f second-opinion pathology: Review of prostate biopsies prior to radical prostatectomy. Am J Surg Pathol 1996; 20: 851–7.

76. Nguyen PL, Schultz D, Renshaw AA, et al. Impact of pathology review on treatment recommendations for patients with adenocarcinoma of the prostate. Urol Oncol. 2004 Jul-Aug; 22(4):295-9.

77. Ozdamar SO, Sarikaya S, Yildiz L, et al. Intraobserver and interobserver reproducibility of WHO and Gleason histologic grading systems in prostatic adenocarcinomas. Int Urol Nephrol 1996; 28:73–7.

78. Rousselet MC, Saint-Andre JP, Six P, Soret JY. Reproductibilite et valeur pronostique des grades histologiques de Gleason et de Gaeta dans les carcinomes de la prostate. Ann Urol (Paris) 1986; 20:317–22.

79. Di Loreto C, Fitzpatrick B, Underhill S, et al. Correlation between visual clues, objective architectural features, and interobserver agreement in prostate cancer. Anat Pathol 1991; 96:70–5.

80. Staradub VL, Messenger KA, Hao N, et al. Changes in breast cancer therapy because of pathology second opinions. Ann Surg Oncol. 2002 Dec; 9(10):982–7.

81. Clauson J, Hsieh YC, Acharya S, et al. Results of the Lynn Sage Second-Opinion Program for local therapy in patients with breast carcinoma. Changes in management and determinants of where care is delivered. Cancer. 2002 Feb 15; 94(4):889–94.

82. Coblentz TR, Mills SE, Theodorescu D. Impact of second opinion pathology in the definitive management of patients with bladder carcinoma. Cancer. 2001 Apr 1; 91(7):1284–90.

83. Ooms EC, Anderson WA, Alons CL, et al. Analysis of the performance of pathologists in the grading of bladder tumors. Hum Pathol 1983; 14:140–3.

84. Sharkey FE, Sarosdy MF. The significance of central pathology review in clinical studies of transitional cell carcinoma in situ [see comments]. J Urol 1997; 157:68–70

85. Oosterlinck W, Kurth KH, Schroder F, Bultinck J, Hammond B, Sylvester R. A prospective European Organization for Research and Treatment of Cancer Genitourinary Group randomized trial comparing transurethral resection followed by a single intravesical instillation of epirubicin or water in single stage Ta, T1 papillary carcinoma of the bladder. J Urol 1993; 149:749–52.

86. Bruner JM, Inouye L, Fuller GN, Langford LA. Diagnostic discrepancies and their clinical impact in a neuropathology referral practice. Cancer. 1997 Feb 15; 79(4):796–803.

87. Hamady ZZ, Mather N, Lansdown MR, et al. Surgical pathological second opinion in thyroid malignancy: impact on patients’ management and prognosis. Eur J Surg Oncol. 2005 Feb; 31(1):74–7.


Для цитирования:


Федянин М.Ю. Взгляд клинического онколога. Как повлияет морфологическое исследование опухолей толстой кишки, мочеполовой системы на тактику лечения? Злокачественные опухоли. 2018;(3s1):96-106.

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. Malignant tumours. 2018;(3s1):96-106. (In Russ.)

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