本文選題：子宮內(nèi)膜樣癌 + MELF浸潤�。� 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：背景與目的子宮內(nèi)膜癌是最常見的女性生殖系統(tǒng)惡性腫瘤之一。近年來,子宮內(nèi)膜癌的發(fā)病率明顯上升,且有年輕化的趨勢,嚴(yán)重威脅我國女性健康。基于不同的起源、臨床病理表現(xiàn)和遺傳學(xué)特征將子宮內(nèi)膜癌分為Ⅰ型和Ⅱ型。子宮內(nèi)膜樣癌是子宮內(nèi)膜癌中最常見的類型,屬于Ⅰ型子宮內(nèi)膜癌,其預(yù)后較好。近年來病理學(xué)界發(fā)現(xiàn)子宮內(nèi)膜癌中存在一種罕見的特殊浸潤方式;即MELF(microcystic elongated and fragmented)浸潤。經(jīng)研究證實(shí)其僅發(fā)生于子宮內(nèi)膜樣腺癌這一組織學(xué)類型中。文獻(xiàn)報(bào)道其僅發(fā)生于低級(jí)別、伴有肌層浸潤的子宮內(nèi)膜樣癌中�？砂l(fā)生于任一臨床分期。目前國內(nèi)外報(bào)道一致認(rèn)為伴有這種特殊浸潤方式的子宮內(nèi)膜癌具有較高的淋巴結(jié)轉(zhuǎn)移率且臨床預(yù)后較差。因此,伴有MELF浸潤的內(nèi)膜癌的正確診斷尤為重要,對指導(dǎo)臨床治療以及患者預(yù)后提供重要的意義。該病變的診斷主要依據(jù)HE染色鏡下觀察進(jìn)行判別,MELF浸潤方式僅位于子宮肌間,可與內(nèi)膜樣腺癌腺體連續(xù)存在或局灶浸潤于肌層。其發(fā)生較為隱匿,僅憑HE組織形態(tài)學(xué)鏡下觀察容易漏診。另外其和肌間脈管及其他組織易混淆,僅憑HE組織形態(tài)學(xué)有誤診的可能。因此,有必要采用免疫組化進(jìn)行輔助診斷。目前輔助診斷子宮內(nèi)膜癌常見的免疫組化指標(biāo):CK、CK7、ER、PR、Vimentin、P16、Ki-67等。根據(jù)文獻(xiàn)報(bào)道的輔助診斷MELF浸潤的免疫組化方法中,CK7能更特異地輔助診斷MELF浸潤。因此,在伴有高度疑似MELF浸潤的子宮內(nèi)膜樣癌病例中可應(yīng)用CK7輔助診斷。但其效果不能完全令人滿意,因此尋找新的輔助診斷MELF的新指標(biāo)為當(dāng)務(wù)之急。此外,關(guān)于MELF的基礎(chǔ)研究中發(fā)現(xiàn):肌動(dòng)蛋白結(jié)合蛋白(Fascin)在正常細(xì)胞和腫瘤細(xì)胞中均可表達(dá)。其表達(dá)上調(diào)與腫瘤細(xì)胞侵襲性增加有著密切關(guān)系。上皮性鈣黏蛋白(E-cadherin)是一種細(xì)胞黏附蛋白,在介導(dǎo)同類細(xì)胞間黏附、細(xì)胞信號(hào)轉(zhuǎn)導(dǎo)中起到一定作用。E-cad失表達(dá)或低表達(dá)是腫瘤發(fā)生侵襲和遠(yuǎn)處轉(zhuǎn)移最重要的機(jī)制之一�，F(xiàn)補(bǔ)做二者可能與MELF浸潤的關(guān)系研究。本研究采用免疫組化方法對23例疑似MELF浸潤的子宮內(nèi)膜樣癌組織中E-cad、Fascin表達(dá)進(jìn)行檢測及臨床病理學(xué)分析,并探討二者在診斷MELF浸潤中的作用。方法收集2011年01月-2015年01月間鄭州大學(xué)第一附屬醫(yī)院經(jīng)全子宮切除術(shù)確診的子宮內(nèi)膜樣癌病例140例。依據(jù)文獻(xiàn)報(bào)道的MELF浸潤的診斷標(biāo)準(zhǔn)進(jìn)行篩選,最終發(fā)現(xiàn)伴有疑似MELF浸潤病例23例。年齡介于45歲-70歲之間,平均年齡58.3歲。實(shí)驗(yàn)運(yùn)用免疫組化方法檢測E-cad、Fascin的蛋白表達(dá),并對上述方法進(jìn)行比較分析。探討其對伴有MELF浸潤的子宮內(nèi)膜樣癌進(jìn)行輔助診斷的可能性。應(yīng)用SPSS 17.0進(jìn)行數(shù)據(jù)分析,定性資料率的比較采用χ2檢驗(yàn),檢驗(yàn)水準(zhǔn)α=0.05。結(jié)果1、23例疑似MELF浸潤C(jī)K7結(jié)果:其中有8例呈彌漫均一強(qiáng)陽性,其周圍內(nèi)膜樣癌腺體陽性強(qiáng)度不一,多為弱陽性或陰性。結(jié)合組織形態(tài)學(xué)診斷為MELF浸潤。故本研究中其發(fā)生率為5.71%(8/140)。2、23例疑似MELF浸潤E-cad結(jié)果:其中有15例呈不連續(xù)弱陽性,其周圍內(nèi)膜樣癌腺體多呈均一、完整的基底膜的染色,少數(shù)呈局灶陽性。結(jié)合組織形態(tài)學(xué)診斷為MELF浸潤。3、23例疑似MELF浸潤Fascin結(jié)果:其中有11例呈陽性,其周圍反應(yīng)性間質(zhì)及間質(zhì)小血管均呈陽性、周圍內(nèi)膜樣癌腺體呈陰性或灶陽性。4、E-cad、Fascin及聯(lián)合二者在診斷MELF浸潤統(tǒng)計(jì)學(xué)結(jié)果:E-cad與CK7在MELF浸潤的檢出率上有統(tǒng)計(jì)學(xué)差異(P0.05)。Fascin與CK7在MELF浸潤的檢出率上無統(tǒng)計(jì)學(xué)差異(P0.05)。聯(lián)合應(yīng)用E-cad和Fascin與CK7對MELF浸潤的檢出率上無統(tǒng)計(jì)學(xué)差異(P0.05)。5、三種方法準(zhǔn)確率的比較結(jié)果:E-cad和Fascin聯(lián)合用于診斷MELF浸潤結(jié)果的符合率(78.26%)高于單獨(dú)使用E-cad(69.57%)和Fascin(60.87%)時(shí)診斷的符合率。且在本實(shí)驗(yàn)中單獨(dú)應(yīng)用Fascin(60.87%)對MELF浸潤診斷的符合率較單獨(dú)應(yīng)用E-cad(69.57%)低。E-cad、Fascin和聯(lián)合二者這三組對診斷MELF浸潤符合率(準(zhǔn)確度)之間無統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論1、E-cad和Fascin可作為輔助診斷子宮內(nèi)膜樣癌伴MELF浸潤,但明確診斷還需結(jié)合組織學(xué)形態(tài),聯(lián)合二者效果更佳。
[Abstract]:Background and objective endometrial carcinoma is one of the most common malignant tumor of female reproductive system. In recent years, the incidence of endometrial cancer has increased significantly and has a tendency to be young. It is a serious threat to the health of women in China. Endometrial carcinoma is divided into type I and type II Types Based on different origins, clinicopathological and genetic features. Endometrium endometrium is divided into endometrium type I and type II. Carcinoma of the endometrium is the most common type of endometrial carcinoma and belongs to type I endometrial carcinoma. It has a better prognosis. In recent years, there is a rare special invasive method in endometrial carcinoma, that is, MELF (microcystic elongated and fragmented) infiltration. It is reported that it occurs only in low grade, myometrium infiltrating endometrioid carcinoma. It can occur at any clinical stage. It is reported that endometrial cancer with this special invasive method has high lymph node metastasis rate and poor clinical prognosis. Therefore, the diagnosis of endometrial carcinoma with MELF infiltration is being confirmed. It is of particular importance to guide clinical treatment and patient prognosis. The diagnosis of this lesion is mainly based on the observation of HE staining. The mode of MELF infiltration is located only in the intermyometrium of the uterus. It can continue to exist or infiltrate into the myometrium with endometrioid adenocarcinoma glands. The onset of the disease is more concealed, only under the HE histomorphology. It is easy to misdiagnose. Besides, it is easily confused with the intermuscular pulse tube and other tissues. It is possible only by HE histomorphology. Therefore, it is necessary to use immunohistochemical method for auxiliary diagnosis. At present, the common immunohistochemical indexes of endometrial carcinoma are diagnosed as CK, CK7, ER, PR, Vimentin, P16, Ki-67, etc. according to the auxiliary diagnosis of the literature. In immunohistochemical methods, CK7 can more specifically assist in the diagnosis of MELF infiltration. Therefore, CK7 assisted diagnosis can be used in cases of endometrioid carcinoma with highly suspected MELF infiltration. But the effect can not be completely satisfactory. Therefore, it is urgent to find a new indicator of the new auxiliary diagnostic MELF. In addition, the basic study on MELF has been found: Actin binding protein (Fascin) can be expressed in normal and tumor cells. The up-regulated expression is closely related to the increase of tumor cell invasiveness. Epithelial calcin (E-cadherin) is a cell adhesion protein that mediates the adhesion between the same cells, and the cell signaling transduction plays a role in.E-cad loss of expression or low expression. It is one of the most important mechanisms of tumor invasion and distant metastasis. The relationship between the two and the MELF infiltration may be studied. The immunohistochemical method was used to examine the expression of E-cad and Fascin in 23 cases of endometrioid carcinoma suspected to be infiltrated, and to analyze the clinical pathology, and to explore the two cases in the diagnosis of MELF infiltration. Methods to collect 140 cases of endometrioid carcinoma diagnosed by total hysterectomy in the First Affiliated Hospital of Zhengzhou University from 01 months of -2015 2011 to 01 months. According to the diagnostic criteria of MELF infiltration reported in the literature, 23 cases with suspected MELF infiltration were found, between the age of 45 and the age of 58.3 years. The average age was 58.3 years old. The protein expression of E-cad and Fascin was detected by immunohistochemical method, and the possibility of the auxiliary diagnosis of endometrioid carcinoma with MELF infiltration was analyzed. The data analysis was carried out with SPSS 17. The comparison of the qualitative data rate using the chi 2 test was used to test the level of alpha =0.05. results of 1,23 cases suspected to be MELF infiltrating CK7. Results: there were 8 cases of diffuse homogeneous strong positive. The positive intensity of endometrioid carcinoma in the surrounding area was not one, mostly weak positive or negative. The diagnosis of MELF infiltration with histomorphology was 5.71% (8/140).2,23 cases suspected of MELF infiltration in E-cad: 15 of them were discontinuous and weak positive, and the surrounding endometrioid carcinoma gland More homogeneous, complete basilar membrane staining, a small number of local focal positive. Combined with histomorphology, MELF infiltrated.3,23 cases suspected MELF infiltration Fascin results: 11 cases were positive, the peripheral reactive interstitial and interstitial small blood vessels were positive, peripheral endometrioid carcinoma glands were negative or.4, E-cad, Fascin and combined two were in the positive. There was no statistical difference between the detection rate of E-cad and CK7 in the infiltration of MELF (P0.05), there was no statistical difference between.Fascin and CK7 in the infiltration of MELF (P0.05). There was no statistical difference in the detection rate of the infiltration between E-cad and Fascin and CK7. The results of the three methods of accuracy were compared with those of the three methods. The coincidence rate of CIN combined with the diagnosis of MELF infiltration (78.26%) was higher than that of E-cad (69.57%) and Fascin (60.87%). In this experiment, the coincidence rate of Fascin (60.87%) for MELF infiltration diagnosis was lower than that of E-cad (69.57%), Fascin and two of the three groups for the diagnosis of MELF. There is no statistical difference between accuracy (P0.05). Conclusion 1, E-cad and Fascin can be used as an auxiliary diagnosis for endometrioid carcinoma with MELF infiltration, but a definite diagnosis should be combined with histological morphology, and the combined effect of the combined two is better.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.33

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