本文選題：子宮內膜癌 + 子宮內膜樣腺癌��； 參考：《河北醫(yī)科大學》2017年碩士論文

【摘要】：目的:子宮內膜癌(Endometrial Carcinoma,EC)是一種上皮性惡性腫瘤,發(fā)生于子宮內膜,是女性生殖道三大惡性腫瘤之一[1],其在女性全身的惡性腫瘤中所占的比例為7%,在女性生殖道惡性腫瘤中所占的比例為20%-30%,其中來源于子宮內膜腺體的腺癌是最常見的類型,在經濟發(fā)達的國家及我國部分經濟發(fā)達的城市,EC的發(fā)病率在婦科惡性腫瘤中的排名已經位居第一,目前其發(fā)病率在全球范圍內有逐漸上升的趨勢[2],目前EC及癌前期病變年輕化趨勢明顯,未生育女性的發(fā)病率較前有所增加,但至今為止,其發(fā)病機制仍沒有完全明確[3],在目前臨床上所有的觀點中,較為認同的是“無抵抗雌激素”學說。根據(jù)其發(fā)病中對于雌激素的依賴與否可以分為兩型:雌激素依賴型(Ⅰ型)和非雌激素依賴型(Ⅱ型)兩種,雌激素依賴型在EC中占大多數(shù),均為子宮內膜樣腺癌,患者相對來說通常比較年輕,而且常伴有肥胖、高血壓、糖尿病、不孕或不育及絕經延遲[4]。Ⅱ型的病理形態(tài)相對少見,該型內膜癌的特點是多見于老年體瘦婦女,至今為止尚未找到明確的發(fā)病原因。環(huán)氧合酶-2(Cyclooxygenase-2,COX-2)是一種誘導性轉錄酶,在正常的生理狀況下機體是檢測不到的,但高表達于多種惡性腫瘤組織,近期研究發(fā)現(xiàn),COX-2在某些腫瘤的細胞增殖、抗凋亡和血管生成等過程中發(fā)揮一定的作用,與腫瘤的發(fā)生、發(fā)展以及預后密切相關[5]。傳統(tǒng)認為,Ⅰ型EC與神經內分泌密切相關,僅有少量的內分泌細胞(Endocrine Cell)存在于正常的子宮內膜中,而在子宮內膜樣腺癌組織中卻比較多見內分泌細胞,至今為止,仍不能明確這些內分泌細胞出現(xiàn)的意義及其與EC生物學行為的關系。嗜鉻粒蛋白A(Chromogranin A,Cg A)是神經內分泌較特異性的標志物。本研究通過檢測COX-2、Cg A在Ⅰ型EC及正常子宮內膜組織中的表達情況,探討兩者在子宮內膜樣腺癌的發(fā)生、發(fā)展中的作用,同時探討兩者在子宮內膜樣腺癌的發(fā)生、發(fā)展過程中的相互關系,評估子宮內膜樣腺癌的預后及為指導子宮內膜樣腺癌的治療開拓新的臨床路徑。方法:1本實驗擇取2014年5月~2016年8月于河北省人民醫(yī)院婦科行手術治療的EC患者52例,其術后送檢切除的子宮,病理結果均是子宮內膜樣腺癌,將子宮內膜樣腺癌的標本作為實驗組。選取同期因子宮或卵巢的良性病變給予全子宮切除的患者22例作為對照組,并且其術后病理結果回報為正常子宮內膜。2采用免疫組化法(SP法)檢測52例子宮內膜樣腺癌及22例正常子宮內膜的石蠟切片中的COX-2、Cg A的表達情況。3分析COX-2、Cg A蛋白的表達與子宮內膜樣腺癌各臨床病理特征之間的關系。4采用SPSS17.0統(tǒng)計學軟件進行統(tǒng)計學分析及處理,P0.05具有統(tǒng)計學意義。5 Spearman相關檢驗分析二者在子宮內膜樣腺癌組織中表達的關系。結果:1 COX-2在正常的子宮內膜組織中的陽性表達率為36.36%,在子宮內膜樣腺癌組織中的陽性表達率為80.77%。子宮內膜樣腺癌組的COX-2的表達率較正常子宮內膜組的表達率要高,兩組比較差異有統(tǒng)計學意義(P0.01)。COX-2的表達與子宮內膜樣腺癌的手術病理分期、肌層浸潤的深度、組織分化的程度和淋巴結的轉移有關。2 Cg A在正常的子宮內膜組織中的表達率為18.18%,而在子宮內膜樣腺癌組織中的表達率則為50.00%。子宮內膜樣腺癌組的COX-2的表達率較正常子宮內膜組的表達率要高,經統(tǒng)計學分析,兩組比較差異有統(tǒng)計學意義(P0.01)。Cg A在子宮內膜樣腺癌中的陽性表達與子宮內膜樣腺癌的手術病理分期、組織學分級、浸潤的深度、淋巴的轉移無明顯相關性。3相關性分析:COX-2和Cg A兩種蛋白在子宮內膜樣腺癌組織中的表達呈正相關(r=0.488 P=0.000)。結論:1 COX-2Ⅰ蛋白在子宮內膜樣腺癌中高表達,與子宮內膜樣腺癌的手術病理分期、深肌層浸潤、組織分化程度低及淋巴結的轉移有一定的相關性,與EC的發(fā)生發(fā)展有一定關系。2 Cg A在子宮內膜樣腺癌中呈高表達,與子宮內膜樣腺癌的手術病理分期、組織學分級、浸潤深度等無明顯相關性。3 COX-2和Cg A在子宮內膜樣腺癌組織中表達呈正相關,可能在內膜癌發(fā)生、發(fā)展中有協(xié)同作用。
[Abstract]:Objective: endometrial carcinoma (Endometrial, Carcinoma, EC) is a kind of malignant epithelial tumors, occurring in the endometrium, is one of the three malignant tumors of female genital tract [1], and its proportion in all female malignant tumor in 7%, which accounted for in the female genital tract malignant tumor in a ratio of 20%-30% which comes from the endometrial gland carcinoma is the most common type of city, in economically developed countries and some of China's economic development, the incidence of EC in gynecological malignant tumor has been ranked in the first place, at present, its incidence in the world within the scope of [2] is rising gradually, the current EC and cancer precancerous lesion of young trend is obvious, the incidence rate of nulliparous women was increased, but so far, its pathogenesis is still not completely clear [3] in clinic at present all view, more identity is "no resistance to estrogen" According to the theory. Its pathogenesis for estrogen dependent or not can be divided into two types: estrogen dependent (type I) and non estrogen dependent (type II) two, estrogen dependent EC in the majority of all endometrial adenocarcinoma, usually were relatively young, and often obesity, hypertension, diabetes mellitus, pathological sterility or infertility and menopause delayed type II [4]. is relatively rare, characteristics of this type of endometrial cancer is more common in older women thin, so far has yet to find a clear cause. Cyclooxygenase -2 (Cyclooxygenase-2, COX-2) is a kind of induced transcription enzyme in physiology under normal conditions the body is not detected, but highly expressed in a variety of malignant tumors, a recent study found that the proliferation of COX-2 cells in some tumors, play a role in anti apoptosis and angiogenesis, and tumor occurrence, development The exhibition is closely related to the prognosis of [5]. and the traditional view that the type of EC and neuroendocrine closely related, only a small amount of endocrine cells (Endocrine Cell) in normal endometrium, and in endometrial adenocarcinoma tissues but more common endocrine cells are still not clear, so far, these endocrine cells appeared and its significance the relationship with the biological behavior of EC. Chromogranin A (Chromogranin A, Cg A) is a marker of neuroendocrine specific. In this study, by detecting the COX-2 expression of Cg A in type EC and normal endometrial tissues, explore both in the occurrence of endometrial adenocarcinoma, development at the same time to explore their role in the occurrence of endometrial adenocarcinoma, the relationship in the process of development, evaluation of prognosis of endometrioid adenocarcinoma and treatment guidance of endometrioid adenocarcinoma development new clinical pathway. Methods: this experiment selects 1 May 2014 ~2016 year in August in Hebei People's Hospital for the surgical treatment of EC patients with 52 cases, the postoperative examination of hysterectomy, pathological results were endometrioid adenocarcinoma, the endometrial adenocarcinoma specimens as the experimental group. The benign lesions were selected to give a full house factor or ovarian uterus resection of 22 patients as the control group, and the postoperative pathology results of normal endometrium.2 by immunohistochemical method (SP method) to detect paraffin sections of 52 cases of endometrial adenocarcinoma and 22 cases of normal endometrium in COX-2 Cg, the expression of A.3 COX-2.4 analysis, the relationship between Cg the expression of A protein in endometrial adenocarcinoma and the clinicopathologic features by using SPSS17.0 statistical software for statistical analysis and processing, P0.05.5 was statistically significant Spearman correlation analysis of two in endometrioid adenocarcinoma The relationship between the expression of cancer tissues. Results: the positive expression of COX-2 in 1 normal endometrial tissue in the rate of 36.36%, the positive expression in endometrial adenocarcinoma tissues the expression of 80.77%. in endometrial carcinoma group COX-2 compared with normal endometrium group was higher, the comparison between the two groups there were statistically significant differences (P0.01) pathology and the expression of.COX-2 in endometrial adenocarcinoma stage, myometrial invasion depth, the degree of expression of tissue differentiation and lymph node metastasis of.2 Cg A in normal endometrial tissue in the rate of 18.18%, while the expression in endometrioid adenocarcinoma tissues the rate for expression of 50.00%. in endometrial cancer group COX-2 compared with normal endometrium group was higher, statistically, there was significant difference between two groups (P0.01).Cg positive expression of A in endometrioid adenocarcinoma and Surgical pathology in endometrial cancer staging, histological grade, infiltration depth, analysis of correlation between.3 associated lymphoid metastasis: no expression of COX-2 was positively related to Cg and A two proteins in endometrioid adenocarcinoma tissues (r=0.488, P=0.000). Conclusion: 1 COX-2 1 protein highly expressed in endometrial adenocarcinoma, pathology and endometrial cancer staging, deep myometrial invasion, metastasis have differentiated and lymph nodes, there is a relationship between.2 Cg A showed high expression in endometrioid adenocarcinoma and the occurrence and development of EC, pathology and endometrioid adenocarcinoma cancer staging, histological grade, depth of invasion, there was no correlation between.3 COX-2 and Cg A expression in endometrial adenocarcinoma tissue was positively correlated, may occur in endometrial carcinoma, synergistic effect in the development.

【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.33

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