發(fā)布時(shí)間：2018-02-16 05:41

  本文關(guān)鍵詞： 毛發(fā)上皮瘤 基底細(xì)胞癌 免疫組織化學(xué)染色 BCL-2 CK15　出處：《河北醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:毛發(fā)上皮瘤(Trichoepithelioma,TE)是一種少見的皮膚良性腫瘤,基底細(xì)胞癌(Basal cell carcinoma,BCC)則是較常見的皮膚惡性腫瘤[1],雖然兩者生物學(xué)來源和良惡性截然不同,但兩者在臨床表現(xiàn)及組織病理學(xué)形態(tài)特征方面較難鑒別。毛發(fā)上皮瘤為好發(fā)于面部的膚色、半透明狀、質(zhì)地堅(jiān)實(shí)的丘疹,生長多年可形成斑塊,有時(shí)可見毛細(xì)血管擴(kuò)張。結(jié)節(jié)型基底細(xì)胞癌為好發(fā)于頭面部的單發(fā)丘疹、結(jié)節(jié),膚色、淺褐色或灰白色,半透明狀,可見毛細(xì)血管擴(kuò)張,生長緩慢,中央可出現(xiàn)糜爛或潰瘍,周邊繞以珍珠樣隆起。兩者于皮疹早期較難區(qū)分。毛發(fā)上皮瘤的組織病理表現(xiàn)為腫瘤團(tuán)塊和角質(zhì)囊腫,腫瘤團(tuán)塊是由類基底細(xì)胞的嗜堿性細(xì)胞組成,邊緣排列成柵欄狀,角質(zhì)囊腫中央為完全角化的物質(zhì),瘤體與周圍間質(zhì)之間可有裂隙。基底細(xì)胞癌的病理表現(xiàn)為,瘤體主要由成簇的基底樣細(xì)胞組成,基底樣細(xì)胞在瘤體周圍呈柵欄狀排列,可見凋亡的單細(xì)胞、纖維粘液基質(zhì)、壞死物質(zhì)組成的混合物,偶見有絲分裂象,瘤體和周圍基質(zhì)形成“癌周間隙”。但是,當(dāng)取材的標(biāo)本太淺或組織太少時(shí),兩者的組織病理學(xué)特征并不明顯,而兩者的臨床處理方法及預(yù)后有著顯著的不同。因此,對毛發(fā)上皮瘤和基底細(xì)胞癌做出正確的診斷,對其臨床治療方案的選擇和愈后的判斷有著極其重要的意義[2-6]。本次研究的目的在于,應(yīng)用免疫組織化學(xué)染色的方法觀察免疫標(biāo)記物BCL-2和CK15[2、5]在毛發(fā)上皮瘤和基底細(xì)胞癌病變中表達(dá)的差異,探討其意義,為臨床鑒別毛發(fā)上皮瘤和基底細(xì)胞癌提供新的方法。方法:采用S-P免疫組化法,檢測12例毛發(fā)上皮瘤患者和22例面部結(jié)節(jié)型基底細(xì)胞癌患者的皮膚標(biāo)本,石蠟包埋組織標(biāo)本,檢測免疫標(biāo)記物BCL-2和CK15在毛發(fā)上皮瘤和基底細(xì)胞癌中的表達(dá)量與表達(dá)模式的差異。應(yīng)用統(tǒng)計(jì)軟件SPSS13.0對所得數(shù)據(jù)進(jìn)行統(tǒng)計(jì)處理和分析,探討其意義。結(jié)果:在這項(xiàng)研究中,對于免疫標(biāo)記物Bcl-2的染色結(jié)果為:12例TE組標(biāo)本中10例染色結(jié)果為陽性,陽性率是83.3%;22例BCC組標(biāo)本中19例染色結(jié)果呈陽性,陽性率為86.4%。對兩組間免疫標(biāo)記物Bcl-2的染色陽性率進(jìn)行比較,P=0.590.05(Pearson的卡方檢驗(yàn)),兩者差別無統(tǒng)計(jì)學(xué)意義。對免疫標(biāo)記物Bcl-2表達(dá)模式的結(jié)果為:TE組中,中央型為2例,所占比例為20%,彌漫型為8例,所占比例為80%;BCC組中央型5例,所占比例為26.3%,彌漫型14例,所占比例為73.7%。對兩組中免疫標(biāo)記物Bcl-2的陽性表達(dá)模式進(jìn)行統(tǒng)計(jì)分析,結(jié)果為P=0.540.05(Pearson的卡方檢驗(yàn)),差異無統(tǒng)計(jì)學(xué)意義。免疫標(biāo)記物CK15染色結(jié)果為:12例TE組標(biāo)本中8例結(jié)果為陽性,陽性率為66.7%;而22例BCC組標(biāo)本中1例染色結(jié)果為陽性,陽性率為4.5%。免疫標(biāo)記物CK15免疫組化染色陽性率TE組明顯高于BCC組,對兩組染色結(jié)果陽性率進(jìn)行統(tǒng)計(jì)分析得出P=0.00790.001(Pearson的卡方檢驗(yàn)),則兩組之間的差異有統(tǒng)計(jì)學(xué)意義。免疫標(biāo)記物CK15染色模式結(jié)果為:在TE組中,陽性表達(dá)結(jié)果則有下三種情況,4例陽性表達(dá)中央型,所占比例為50%;有1例陽性表達(dá)為外周性,所占比例為12.5%;有3例陽性表達(dá)為彌漫性,所占比例為37.5%;在BCC組中1例陽性表達(dá)為中央型。結(jié)論:1免疫標(biāo)記物CK15可用于臨床毛發(fā)上皮瘤與基底細(xì)胞癌的鑒別。2免疫標(biāo)記物BCL-2對于臨床鑒別毛發(fā)上皮瘤與基底細(xì)胞癌意義不大。
[Abstract]:Objective: trichoepithelioma (Trichoepithelioma, TE) is a rare benign tumor of the skin, basal cell carcinoma (Basal cell carcinoma, BCC [1]) is a common skin malignant tumor, although both benign and malignant biological sources and different, but both in clinical and pathological morphology study is difficult to identify trichoepithelioma. For good hair in the face of the skin, translucent texture, firm papules, growth years can form plaques, sometimes visible telangiectasia. Nodular basal cell carcinoma is good in the head and face of Solitary Hill rash, nodules, color, light brown or gray white, translucent, visible telangiectasia. Slow growth, the central can appear erosion or ulcer surrounding around to the Pearl like uplift. Both in early rash is difficult to distinguish. The pathological trichoepithelioma showed tumor mass and keratin cyst, tumor mass is Composed of basaloid cells and basophilic cells, edge arranged in palisade, fully keratinized keratin cyst central material, can have a break between the tumor and the surrounding stroma. The pathological features of basal cell cancer, the tumor is mainly composed of basaloid cell clusters composed of basaloid cells palisading in around the tumor, single cell apoptotic, mucus fiber matrix, a mixture of necrotic material composition, occasional mitotic figures, the tumor and the surrounding matrix to form a "cancer week gap". However, when the specimens from the organization is too light or too little, the pathological characteristics and clinical is not obvious. The treatment method and prognosis is significantly different. Therefore, the correct diagnosis of trichoepithelioma and basal cell carcinoma, and the clinical treatment options and prognosis judgment is very important for the purposes of this study [2-6]. Is that the method of immunohistochemical staining to observe the expression of immunological markers BCL-2 and CK15[2,5] in lesions of trichoepithelioma and basal cell carcinoma and discuss its significance, provide a new method for clinical diagnosis of trichoepithelioma and basal cell carcinoma. Methods: using S-P immunohistochemical method to detect 12 cases of trichoepithelioma tumor patients and 22 cases of nodular basal cell carcinoma in patients with facial skin specimens of paraffin embedded tissue specimens, detection of different immune markers BCL-2 and CK15 expression in trichoepithelioma and basal cell carcinoma and expression pattern. Using the SPSS13.0 statistical software for processing and analysis of data, to explore its significance results: in this study, the immune marker Bcl-2 staining results: 12 cases in group TE were 10 cases staining results were positive, the positive rate was 83.3%; 22 cases in group BCC were 19 cases of positive staining results And the positive rate was 86.4%. positive rate between the two groups of immune markers Bcl-2, P=0.590.05 (chi square test of Pearson), the difference was not statistically significant. The immune marker expression pattern of Bcl-2 results: TE group, 2 cases of central type, the proportion of 20%, diffuse type 8 cases, accounting for 80%; 5 cases in group BCC were central type, accounted for 26.3%, 14 cases of diffuse type, the proportion of 73.7%. on the immune markers in the two groups of Bcl-2 positive expression patterns were analyzed, the results of P=0.540.05 (chi square test of Pearson), no significant difference the significance of immune markers CK15 staining. Results: 12 cases of TE group were 8 cases were positive, the positive rate was 66.7%; while 22 cases in group BCC were 1 cases staining results were positive, the positive rate was 4.5%. immunohistochemical marker for immunohistochemical staining of CK15 positive rate of TE group was significantly higher than that in group BCC, the the two group staining results The positive rate of statistical analysis of P=0.00790.001 (chi square test of Pearson), it was statistically significant differences between the two groups. The immune marker CK15 staining pattern results in the TE group, the positive results had three cases, 4 cases of positive expression of central type, accounted for 50%; 1 patients with positive expression of peripheral, accounted for 12.5%; 3 cases were positive expression was diffuse, accounted for 37.5%; 1 cases in group BCC positive expression for the central type. Conclusion: 1 immune marker CK15 can be used for clinical trichoepithelioma and basal cell carcinoma with.2 immune markers BCL-2 for the differential diagnosis of trichoepithelioma and basal cell carcinoma.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R739.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 陽桂麗;鐘先榮;胡碧清;聶洪華;;毛發(fā)上皮瘤與基底細(xì)胞癌的臨床病理及免疫組化比較(附74例報(bào)告)[J];廣西醫(yī)學(xué);2012年09期

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本文編號：1514787