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<< 学会誌へ戻る The failure of radical surgery and chemotherapy in reducing the overall mortality of ovarian cancer can be attributed to a lack of understanding of its pathogenesis, especially the cell of origin of ovarian cancer. The current paradigm is that epithelial ovarian cancer（EOC）arises from the ovarian surface epithelium（OSE). OSE more closely resembles the mesothelium lining the peritoneal cavity with which it is continuous, rather than the various histologic types of ovarian carcinoma（serous, endometrioid and clear cell carcinoma）which have a Müllerian phenotype. Accordingly, it has been argued that the OSE undergoes a process termed “metaplasia” to account for this profound morphologic transformation. However, accumulated evidence from recent clinicopathological, immunohistochemical and molecular genetic studies strongly suggests that the cell of origin of most EOCs resides in extraovarian organs. In particular, it appears that both high-grade and low-grade serous carcinomas are most likely derived from fallopian tubal epithelium. Most high-grade serous carcinomas are believed to develop from dissemination of serous tubal intraepithelial carcinoma（STIC）cells that are derived from tubal epithelium, whereas low-grade serous carcinoma progresses from an ovarian borderline tumor, which developed from tubal epithelium shed from “papillary tubal hyperplasia” or tubal epithelium that had formed an ovarian cortical inclusion cyst. Finally, ovarian endometrioid and clear cell carcinomas arise from ectopic endometrium implanted on the ovary（endometrioma). Therefore, it now appears that the majority of EOCs develop from implanted tumor precursors imported from either the fallopian tube or the endometrium rather than from the OSE itself. Although there are several critical experiments that are still needed to confirm this model, the new paradigm of the extraovarian origin of EOCs will have profound implications for research and clinical management including prevention and early detection of ovarian cancer. 関東連合産科婦人科学会誌, 51(3) 354-354, 2014 |
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一般社団法人関東連合産科婦人科学会事務局 〒102-0083 東京都千代田区麹町4-7 麹町パークサイドビル402 株)MAコンベンションコンサルティング内 TEL：03-3288-0993 FAX：03-5275-1192 E-mail：kantorengo@jsog-k.jp Copyright (C) 一般社団法人関東連合産科婦人科学会 |