BCL-2和CK15在毛发上皮瘤和基底细胞癌中的表达及其意义

发布时间：2018-02-16 05:41

本文关键词： 毛发上皮瘤基底细胞癌免疫组织化学染色 BCL-2 CK15　出处：《河北医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:毛发上皮瘤(Trichoepithelioma,TE)是一种少见的皮肤良性肿瘤,基底细胞癌(Basal cell carcinoma,BCC)则是较常见的皮肤恶性肿瘤[1],虽然两者生物学来源和良恶性截然不同,但两者在临床表现及组织病理学形态特征方面较难鉴别。毛发上皮瘤为好发于面部的肤色、半透明状、质地坚实的丘疹,生长多年可形成斑块,有时可见毛细血管扩张。结节型基底细胞癌为好发于头面部的单发丘疹、结节,肤色、浅褐色或灰白色,半透明状,可见毛细血管扩张,生长缓慢,中央可出现糜烂或溃疡,周边绕以珍珠样隆起。两者于皮疹早期较难区分。毛发上皮瘤的组织病理表现为肿瘤团块和角质囊肿,肿瘤团块是由类基底细胞的嗜碱性细胞组成,边缘排列成栅栏状,角质囊肿中央为完全角化的物质,瘤体与周围间质之间可有裂隙。基底细胞癌的病理表现为,瘤体主要由成簇的基底样细胞组成,基底样细胞在瘤体周围呈栅栏状排列,可见凋亡的单细胞、纤维粘液基质、坏死物质组成的混合物,偶见有丝分裂象,瘤体和周围基质形成“癌周间隙”。但是,当取材的标本太浅或组织太少时,两者的组织病理学特征并不明显,而两者的临床处理方法及预后有着显著的不同。因此,对毛发上皮瘤和基底细胞癌做出正确的诊断,对其临床治疗方案的选择和愈后的判断有着极其重要的意义[2-6]。本次研究的目的在于,应用免疫组织化学染色的方法观察免疫标记物BCL-2和CK15[2、5]在毛发上皮瘤和基底细胞癌病变中表达的差异,探讨其意义,为临床鉴别毛发上皮瘤和基底细胞癌提供新的方法。方法:采用S-P免疫组化法,检测12例毛发上皮瘤患者和22例面部结节型基底细胞癌患者的皮肤标本,石蜡包埋组织标本,检测免疫标记物BCL-2和CK15在毛发上皮瘤和基底细胞癌中的表达量与表达模式的差异。应用统计软件SPSS13.0对所得数据进行统计处理和分析,探讨其意义。结果:在这项研究中,对于免疫标记物Bcl-2的染色结果为:12例TE组标本中10例染色结果为阳性,阳性率是83.3%;22例BCC组标本中19例染色结果呈阳性,阳性率为86.4%。对两组间免疫标记物Bcl-2的染色阳性率进行比较,P=0.590.05(Pearson的卡方检验),两者差别无统计学意义。对免疫标记物Bcl-2表达模式的结果为:TE组中,中央型为2例,所占比例为20%,弥漫型为8例,所占比例为80%;BCC组中央型5例,所占比例为26.3%,弥漫型14例,所占比例为73.7%。对两组中免疫标记物Bcl-2的阳性表达模式进行统计分析,结果为P=0.540.05(Pearson的卡方检验),差异无统计学意义。免疫标记物CK15染色结果为:12例TE组标本中8例结果为阳性,阳性率为66.7%;而22例BCC组标本中1例染色结果为阳性,阳性率为4.5%。免疫标记物CK15免疫组化染色阳性率TE组明显高于BCC组,对两组染色结果阳性率进行统计分析得出P=0.00790.001(Pearson的卡方检验),则两组之间的差异有统计学意义。免疫标记物CK15染色模式结果为:在TE组中,阳性表达结果则有下三种情况,4例阳性表达中央型,所占比例为50%;有1例阳性表达为外周性,所占比例为12.5%;有3例阳性表达为弥漫性,所占比例为37.5%;在BCC组中1例阳性表达为中央型。结论:1免疫标记物CK15可用于临床毛发上皮瘤与基底细胞癌的鉴别。2免疫标记物BCL-2对于临床鉴别毛发上皮瘤与基底细胞癌意义不大。
[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.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R739.5

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