肾母细胞瘤介入治疗后的病理学研究

Pathological alterations of Wilm′s tumor after interventional chemotherapy

目的探讨介入治疗对肾母细胞瘤病理学的影响。方法对30例术前介入治疗后的肾母细胞瘤与16例术前化疗、17例单纯手术组的肿瘤和20例曾作芯针活检的组织进行病理观察对照研究。对三组各15例组织作TUNEL染色与SP法免疫组化染色检测肿瘤凋亡和PCNA表达。结果介入组肿瘤纤维性假包膜厚度平均2.4±0.7mm,平均坏死面积占肿瘤77.5%,肿瘤内中型血管坏死闭锁率达93.3%,瘤体内均见淡黄色碘油残留及大片泡沫状组织细胞浸润;化疗组纤维性假包膜厚度平均2.1±0.9mm,平均坏死面积占肿瘤51.2%。中型血管坏死闭锁率达43.8%。单纯手术组纤维性假包膜厚度平均1.1±0.4mm,平均坏死面积占肿瘤14%,瘤体内未见中型血管坏死及闭锁。介入组术前芯针活检结果与术后瘤体病理比较发现间叶型,术后瘤体坏死相对较少,其余类型坏死均较明显,尤以胚芽型为甚。介入组与单纯手术组相比肿瘤细胞增殖活性明显降低,凋亡细胞显著增多,但与化疗组相比无差异。结论术前介入治疗,能使瘤体内血管迅速坏死、闭锁、肿瘤大片坏死,同时伴有纤维组织增生、纤维性假包膜形成;肿瘤内碘油长期滞留及泡沫状组织细胞浸润,有利于肿瘤细胞杀灭作用;组织类型与治疗敏感性有关;介入治疗也可通过抑制细胞增殖,诱导凋亡达到控制肿瘤的目的。

Purpose To discuss the effect of interventional chemotherapy on the pathological change of Wilm＇s tumor. Methods A comparative analysis of pathological findings was made in 30 cases of Wilm＇s tumor subjected to interventional chemotherapy before operation, 16 Wilm＇s tumors with chemical therapy before operation, 17 Wilm＇s tumor tissues without any therapy before operation and 20 Wilm＇s tumor tissues obtained by needle biopsy. TUNEL staining and SP immunohistochemical staining were used to detect the tumor cell apoptosis and the expression of PCNA in every 15 tissues of the former three groups. Results In the interventional therapy group, the average thickness of pseudo fibrous capsule was 2. 4± 0. 7 mm, the ratio of the average necrosis area to the whole tumor area was 77.5%, and 93.3 per cent of middle vessels became occlusion. In addition, yellowy lipiodol emulsion left and lots of foaming histiocytes infiltration were observed in all the tumor cases; in the chemical therapy group, the average thickness of pseudo fibrous capsule was 2. 1 ±0. 9 mm, the ratio of the average necrosis area to the whole tumor area was 51.2% , 43.8 per cent of middle vessels became occlusion ; in the only operation group, the average thickness of pseudo fibrous capsule was 1.1 ± 0.4 mm, the ratio of the average necrosis area to the whole tumor area was 14% , and no middle - sized vessels became occlusion. Compared with the histological changes of needle biopsy in interventional group before and after operations, necrosis was seldom observed in mesenchymal type but prominent in other type, especially in embryonic type. The tumor proliferating activity decreased significantly in the interventional therapy group than in the only operation group. On the other side, the apoptotic cells increased significantly but no difference from that in chemical therapy group. Conclusions Interventional chemotherapy before operation can promote vessel necrosis and occlusion, massive tumor necrosis with fibrous tissue proliferation and pseudo fibrous capsule formation ; Yellowy lipiodol emulsion left and a lot of foaming histiocytes infiltration can help kill tumor cells; Histologic type of tumors is related to therapy sensitivity; Interventional therapy can inhibit tumor development by suppressing tumor cell proliferation and inducing tumor cell apoptosis.