子宫颈不典型不成熟鳞化免疫组化表达的意义

Significance of the immunophenotype of atypical immature metaplasia in cervix

目的探索子宫颈不典型不成熟鳞状化生(atypical immature metaplasia,AIM)的生物学行为。方法采用SP法免疫组化技术检测p63、CK5、Ki-67及p16在14例AIM中的表达;对照7例不成熟鳞化(immature metaplasia,IM),7例低级别鳞状上皮内病变(LSIL),3例高级鳞状上皮内病变(HSIL)和7例鳞状细胞癌(SCC)。结果p63和CK5在AIM和IM阳性率>75%,p63在AIM与LSIL和HSIL中的表达差异有显著性(P<0.05),与SCC差异无显著性。AIM与IM中Ki-67总平均指数及分布幅度相近,AIM(43.23%)略高于LSIL(36.95%),较明显低于HSIL(68.5%,P>0.05),从Ki-67阳性细胞分布范围比较,AIM与LSIL及HSIL有重叠。p16在AIM表达6例强阳性、6例局灶阳性、2例阴性,7例SCC及3例HSIL全呈强阳性,3例LSIL强阳性,4例局灶阳性。结论p63和CK5佐证AIM形态特征。p63与Ki-67同样表达在异型细胞阳性。p16阳性表达与Ki-67和p63相结合,具有LSIL和HSIL的诊断价值,但p16阴性和Ki-67低表达,不排除AIM向良性转化可能。AIM是属于子宫颈上皮表现为一异质性病变。

Purpose To investigate the biological behavior of atypical immature metaplasia AIM） in cervix.Methods Immunohistochemical technique was used to detect the expression of p63, CKS, Ki-67 and p16 in 14 cases of cervical AIM, 7 cases of immature metaplasia （IM） ,7 low-grade squamous intraepithelial lesion （LSIL） ,3 high-grade squamous intraepithelial lesion （HSIL） and 7 cases of squamous cell carcinoma （SCC） in cervix were used as control. Results p63 and CK5 expression was scored as positive at more than 75% in AIM. p63 expression was significantly different（P 〈0. 05） from LSIL and HSIL, but not from SCC. General average index and distribution range of Ki-67 between AIM and IM was close, which was slightly higher than that in LSIL, but distinctly lower than that in HSIL（P 〉0. 05）, As compared with positive ranges of Ki-67 ,there was an overlapped among AIM, LSIL and HSIL. p16 was scored as strong positive in 6 cases of AIM, local positive in 6 cases of AIM and negative in two cases. 7 cases of SCC and 3 HSIL and 3 LSIL were strong positive for p16, Conclusions p63 and CK5 staining proves the morphological features of AIM, p63 is also expressed in Ki-67 positive atypical cells. Positive p63 staining combined with Ki-67 and p16 has differentially diagnostic value between LSIL and HSIL,but negative p16 and low-expression of Ki-67 do not exclude the probability of the transformation of AIM to benign lesion. AIM falls into a heterogenous lesion in cervix.