摘要
目的探讨子宫颈非典型性不成熟鳞状上皮化生(AIM)与子宫颈CINⅢ形态学及增殖分化特征的差异。方法采用形态学观察,AB黏液组化染色,细胞增殖相关抗原Ki-67和角蛋白(CK)10、14免疫组化染色方法,观察55例原诊断为CINⅢ的病例和14例子宫颈息肉伴成熟性鳞状上皮化生(OSM)组织病理学特征,黏液残留情况,细胞增殖活性和分化程度;采用半巢式PCR检测HPV16E6DNA。结果(1)参照Crum的组织学诊断标准,在CINⅢ中有1例经组织形态观察符合AIM的诊断标准,即重新诊断为AIM;(2)根据鳞状上皮中的黏液残留情况,从55例CINⅢ中鉴别出7例AIM;(3)AIM的Ki-67表达高于OSM(P=0.022),明显低于CINⅢ(P=0.000)差异有统计学意义;(4)CK10在AIM和CINⅢ中的表达差异有统计学意义(P=0.000);CK14在AIM和CINⅢ组间的表达差异无统计学意义(P=1.000);(5)AIM的HPV16感染检出率为71.4%与CINⅢ的检出率85.4%相比差异无统计学意义(P=0.321)。结论在Crum的AIM形态学诊断标准基础上,结合本研究中各项指标的研究结果,本研究提出AIM与CINⅢ的鉴别诊断依据:①核分裂象数≤15/10HPF,位于上皮下1/3层;②病理性核分裂象罕见;③AB染色显示有黏液残留;④Ki-67PI<50%;⑤CK10弥漫表达于除基底副基底层外黏膜上皮各层。
Purpose To investigate the different histopathological features, proliferation and differential characteristics between atypical immature metaplasia （ AIM ） of cervix and cervical interepithelial neoplasia grade Ⅲ （ CIN Ⅲ ）. Methods 55 cases of originally diagnosed CIN m and 14 cases of ordinary squamous metaplasia of cervical polyps （OSM） were enrolled in the study. Histopathological features were observed in these samples. The mucous residual status and the degree of cell proliferation and differentiation were detected by morphological analyses, Aleian-blue stain and immunohistoehemical staining of Ki-67, keratin 10, 14. High-grade HPV （HPV16） infection of those cases were also detected by semi-nested PCR methods. Results （ 1 ） One case of CIN Ⅲ was re-diagnosed as AIM based on Crum＇s diagnostic standard ; （2） According to the state of mucous residue in squamous epithelium, 7 out of 55 cases of CIN m were diagnosed as AIM; （3） Ki-67 expression in AIM was significantly higher than that of OSM （P = 0. 022 ）, but much lower than that of CIN Ⅲ（ P = 0. 000） ; （4） Difference of the expression of keratin 10 in AIM and CIN Ⅲ was significant （P = 0. 000） ; but the expression of keratin 14 had no significant differences between AIM and CIN m groups（ P =0. 240） ; （5） Infection rate of HPV16 had no significant difference between AIM （71.4%） and CIN Ⅲ （85.5%, P = 0. 321 ）. Conclusion Based on Crum＇s diagnostic standards and combined with results of multi-methodologies, we propose following criteria for differential diagnosis of AIM from CIN Ⅲ：① mitosis≤1/10 HPF, at the lower 1/3 layers of epithelium; ② pathological mitosis is rare; ③ AB stain shows residual mucus ; ④Ki-67 PI 〈 50% ; and ⑤ CKIO is strongly positive in each layer of epithelium except basal and sub-basal layers.
出处
《临床与实验病理学杂志》
CAS
CSCD
北大核心
2008年第4期423-428,共6页
Chinese Journal of Clinical and Experimental Pathology
