【作者】 赵娜；

【导师】 张红； 陈奎生；

【作者基本信息】 郑州大学 ， 临床病理学， 2016， 硕士

【摘要】 背景与目的宫颈癌是妇科最常见的恶性肿瘤之一,同时也是引起35~45岁女性死亡的主要疾病之一。据统计宫颈癌发病率居世界第二位,目前全世界每年约有50万宫颈癌新增病例,近30万人死亡。宫颈癌的病理类型主要包括鳞状细胞癌、腺癌、腺鳞癌、小细胞癌、未分化癌和其他类型的癌等,其中宫颈鳞状细胞癌占80%左右,宫颈腺癌占10%左右,因此宫颈鳞状细胞癌是引起女性死亡的原因之一。为了广大女性身心健康,宫颈病变可通过有效的、规律的微小筛查并及时发现宫颈癌前病变与微小浸润性鳞状细胞癌,进而及时进行恰当的处理与治疗是预防宫颈癌的发生、降低宫颈癌死亡的关键所在。尽管随着经济水平的逐渐提高与全民健康意识的逐步加强,同时宫颈脱落细胞学筛查技术也已于全社会各层次得到普遍应用,但不排除未筛查检出可能,故其死亡率在发展中国家仍为第一位,特别是其发病年龄也逐渐趋于年轻化。目前,国内外观点一致认为,宫颈的良性病变或者鳞状上皮内病变主要以药物治疗或者宫颈锥切为主,宫颈的微小浸润性鳞状细胞癌可依据多种因素选择不同的手术方式,但对育龄期的女性来说,宫颈锥切是最佳的手术方式,因此宫颈病变尤其是宫颈微小浸润性鳞状细胞癌与宫颈浸润性鳞状细胞癌的准确区分与诊断显得尤为重要。目前,对宫颈微小浸润性鳞状细胞癌是否发生浸润及浸润程度的鉴别诊断具有极大地挑战性,其诊断指标主要包含:浸润宽度,浸润深度及基底膜缺失程度。前二者的测量主要依据HE染色镜下观察进行判别,基底膜的测量主要依据免疫组化、Masson染色等辅助诊断技术,HE主观性较强,存在较大的个体差异性,同时重现性较差。相对来讲,基底膜完整性检测易于判别,结果相对客观。基底膜广泛存在于人体上皮与间质之间,其主要成分是IV型胶原、LN和纤维连接蛋白,而IV型胶原是基底膜中最丰富的蛋白,是由上皮细胞产生,分泌到细胞外基质中,约占基底膜总蛋白含量的50%。基底膜完整性可作为判断浸润与否、微小浸润的指标之一,故对基底膜中胶原含量的测定可以辅助诊断微小浸润性鳞状细胞癌。本研究采用免疫组化与Masson染色技术对微小浸润性鳞状细胞癌进行病理学分析,旨在对比分析二者的优缺点;关于Masson特殊染色在快速冰冻中辅助诊断微小浸润性鳞状细胞癌的重要作用有待进一步研究。方法收集2008年01月~2015年01月间郑州大学第一附属医院病理科经宫颈活检或宫颈锥切的疑似宫颈微小浸润性鳞状细胞癌病例108例,年龄介于21岁~67岁之间,平均年龄43.4岁。依据WHO以及FIGO对宫颈微小浸润性鳞状细胞癌诊断标准:(1)弥漫性CINⅢ;(2)宫颈隐窝腺体广泛性、膨胀性,深部受累;(3)腺腔内有坏死,有上皮内鳞状细胞成熟现象;(4)浸润深度≤5mm,宽度≤7mm进行筛选,实验运用免疫组化及Masson染色技术对微小浸润性鳞状细胞癌进行辅助诊断,并对上述两种方法进行比较分析。采用SPSS 17.0统计软件进行分析,率的比采用Mann~Whitney Test(秩和检验)或Fisher精确检验,检验水准采取α=0.05。结果免疫组化染色结果:60例(55.6%)病灶周边基底膜样物质减少或者部分缺如,结合组织学形态及免疫组化结果诊断为宫颈微小浸润性鳞状细胞癌;24例(22.2%)病灶周边基底膜完整着色,结合组织学形态及免疫组化结果将其暂定为宫颈鳞状上皮内病变,但不排除因上皮脚横切或斜切面造成的假象;24例(22.2%)病灶周边基底膜完全缺如,故将其诊断为宫颈浸润性鳞状细胞癌。Masson染色结果;70例(64.8%)病灶周边基底膜样物质减少或部分缺失,结合组织学形态及免疫组化结果诊断为宫颈微小浸润性鳞状细胞癌;20例(18.5%)病灶周边基底膜完整着色,结合组织学形态及免疫组化结果将其暂定为宫颈鳞状上皮内病变,但不排除因上皮脚横切或斜切面造成的假象;18例(16.7%)病灶周边基底膜完全缺如,将其诊断为宫颈浸润性鳞状细胞癌。结论Masson染色法与免疫组化IV胶原着色在辅助诊断宫颈微小浸润性鳞状细胞癌中起着同等重要的作用。更多还原

【Abstract】 Background and objectiveWorldwide, the uterine cervical carcinoma is one of the most common malignancies and the second reason for cancer mortality in women.It is a leading cause of death among women between 35 and 45 years.Currently,cervical cancer is in females in the world with around 500,000 new cases and300,000 deaths occurring annually. The uterine cervical carcinoma cludes squamous cell carcinoma, adenosquamous carcinoma, small cell carcinoma, undifferentiated carcinoma and so on. Among others, squamous cell carcinoma(SCC) accounts for 80.0% of carcinomas of the uterine cervix, which cause of death for females with one of the primary disease and adenocarcinoma(AC) for 10.0%. we make effective and regular early screening for finding out precancerous lesion(PL) or early squamous cell carcinoma of cerix, We properly deal with treatment,which is the key to prevention of cervical cancer and reduce the incidence of cervical cancer. Though with the economic level being raised and the health consciousness being increased, at the same time, the widespread use of a screening method. Nonetheless, the first in the developing countries with a high mortality if it is not diagnosed early. What’s more, it tend to be younger.Currently,agree that both at home and abroad,the cervical benign lesions or squamous intraepithelial lesions(SIL)are mainly composed of medication or cervical cone cutting,microinvasive squamous cell carcinoma can choose different ways of operation on the basis of a number of factors. But for women of childbearing age, the cervical cone cutting is the optimal choice of operation method. For cervical lesions especially in microinvasive squamous cell carcinoma and invasive squamous cell carcinoma of correct differentiation and diagnosis is particularly important. At present, the degree of cervical squamous cell carcinoma in infiltration and infiltration of differential diagnosis has greatly challenging and its diagnostic indicators mainly include: width of infiltration, infiltration depth and lack of basement membrane. Before the measurement of both the main according to the criterion of HE staining microscopic observation, the measurement of basement membrane based primarily on immunohistochemical, Masson dyeing auxiliary diagnostic techniques, HE subjectivity is stronger, there are large individual differences, and poor reproducibility. Relatively speaking, the basement membrane integrity testing is easy to distinguish, the result is relatively objective.In the human body,basement membrane that consist of type IV collagen, LN protein and fiber connections widely exists between epithelial and mesenchymal, but the type IV collagen is the most abundant protein in the basement membrane, is produced by the epithelial cells and secreted into the extracellular matrix, accounts for about 50% of the basement membrane total protein content.Basement membrane integrity, tiny infiltration index can be able to judge that infiltration exist or not, one of the reason for the determination of collagen content in the basement membrane can apply to the diagnosis of small invasive squamous cell carcinomaA comparison of the diagnosis result of infiltrating small invasive squamous cell carcinoma cancer of Immunohistochemical technique and Mason staining method has been made in this study to learn the advantages and disadvantages of both technique, About Masson special dyeing auxiliary diagnosis in quick freezing small invasive squamous cell carcinoma of the important role, which needs further research MethodsCollecting the 108 cases of Suspected small invasive squamous cell carcinoma,which were from Department of Pathology The First Affiliated Hospital of Zheng Zhou University during 2008~2015 annual, The average age is 43.3 year old(21~67years old), at the same time they were the surgical treatment. According to the WHO and the FIOG gives the definition of microinvasive squamous cell carcinoma:(1) Diffuse Cervical Intraepithelial Neoplasia 3,(2)Cervical fossae glands universality, swelling, deep involvement;(3) Lumens with necrosis, with intraepithelial squamous cells mature;(4) Infiltration depth of 5 mm or less, width of 7 mm or less, which is screening. This experiment takes the immunohistochemical staining and Masson to diagnose small invasive squamous cell carcinoma, which analyzes and compares to the two methods.SPSS Statistics software version 17.0 was used for the statistical analysis, the rate of inspection uses Mann-Whitney Test or Fisher Precise inspection, A level of P < 0.05 was considered statistically significant. ResultsThe result of Immunohistochemical method: Around 60 cases(55.6%) lesions of basement membrane reduce or absent, Combining with the characteristics of morphology and IHC confirmed for microinvasive cervical squamous cell carcinoma; Around 24(22.2%)lesions of basement membrane don‘t reduce, Not to mention the lack of such as,It temporarily named cervical squamous cell carcinoma in situ, But do not rule out caused by crosscutting epithelial foot or diagonal plane illusion; Round 24(22.2%) lesions of basememt membrane completely lost, Then a diagnosis of cervical invasive squamous cell carcinoma.The result of Masson staining: Around 70 cases(64.8%) lesions of basement membrane reduce or absent, Combining with the characteristics of morphology and Masson staining confirmed for microinvasive cervical squamous cell carcinoma;Around 20(18.5%)lesions of basement membrane don’t reduce, Not to mention the lack of such as,It temporarily named cervical squamous cell carcinoma in situ, But do not rule out caused by crosscutting epithelial foot or diagonal plane illusion; Round 18(16.7%) lesions of basememt membrane completely lost, Then a diagnosis of cervical invasive squamous cell carcinoma. ConclusionsMasson staining and immunohistochemical IV collagen staining in the auxiliary diagnosis Microinvasive cervical squamous cell carcinoma play an equally important role.更多还原