创伤继发假性上皮瘤样增生病变中上皮细胞去分化机制的探讨

Investigation of epithelial cells dedifferentiated mechanism in the pseudoepitheliomatous hyperplasia(PEH)associated with wound healing

目的 为探讨创面愈合相关的假性上皮瘤样增生 (PEH)病变组织中上皮细胞去分化的发生机制。方法 将 11例来自临床创 (烧 )伤后继发PEH病变及其边缘正常皮肤 6例 (PEH N)标本 ,采用组织病理学和电子显微镜技术观察PEH上皮组织形态改变 ,并结合免疫组化抗原标记技术 ,观察抗人广谱细胞角蛋白 (p CK)、CK19、Bcl 2和增殖细胞核抗原 (PCNA)在PEH组织中定位和分布特征。结果 与PEH N组相比 ,PEH呈现鳞状上皮化生 ,间质密布微血管结构和炎症免疫细胞 ,可见表皮结构崩溃和细胞脱落 ;超微结构显示上皮基底细胞变形和细胞间隙增宽 ,可见肿瘤样细胞和单核细胞样细胞等异常分化细胞从原细胞浆膜“壳”结构孵出。在相同部位免疫组化显示 ,对Bcl 2和PCNA的免疫反应活性增强而缺失p CK和CK19标记的“基底细胞”从 p CK阳性的角蛋白框架内脱出 ,而在增生性上皮组织中央部位细胞则呈现CK19和Bcl 2强阳性的交织。结论 在PEH组织中丧失分化和表皮结构形成能力的表皮基底细胞呈脱壳样与原细胞浆膜结构分离 ,是基底细胞去分化的典型形态特征。在上皮

Objective To investigate the occurrenca mechanism of epithelial cells dedifferentiation in the pseudoepitheliomatous hyperplasia(PEH)lesion associated with wound healing.Methods Morphological change of epithelial tissue was investigated with histopathological technique and electronic microscope method in 11 specimens of PEH lesions and 6 specimens of normal skin from PEH edge(PEH-N).The expression characteristics and distribution of pan-cytokeratin(p-CK),CK19,Bcl-2 and proliferating cell nuclear antigen(PCNA)in PEH were detected with immunohistochemical methods.Results In comparison with PEH-N,PEH contained squamous metaplasia,inflammatory cells,immunologic cells and microvessels massively aggregated in mesenchyme,and epithelial basal cells were apart from basal membrane.In the ultrastructure,some deforming epithelial basal cells eloosoned cell-cell junction,and some abnormally differentiated cells,such as neonatal tumor-like cells and monocytoid cells brooded from former plasmalemma 'shell' of original epithelial cells .The expression of p-CK and CK19 protein was decreased,and the immuno-staining of Bcl-2 and PCNA was apparently increased in epithelial basal cells which were apart from p-CK positive framework of cytokeratin,while the epithelial cells in central part of hyperplastic epithelial tissue strongly expressed CK19 and Bcl-2 protein.Conclusion The loss of the ability of differentiation and epithelial formation and the harvest of the capability of brooding from former plasmalemma 'nutshell' of original epithelial cells might be the typically morphological characteristics of the dedifferentiated basal cells in PEH.The unique microenvironment of the interface of epithelial and interstitial tissues may play a couveuse-like function in epithelial cells dedifferentiation.