催产素受体在鉴别子宫平滑肌肿瘤及子宫内膜间质肉瘤中的应用

The role of Oxytocin Receptor in Distinguishing Between Uterine Smooth Muscle Tumors and Endometrial Suromal Sarcoma

目的研究催产素受体在正常子宫、子宫平滑肌肿瘤、子宫内膜间质肉瘤中的表达，以利于不同肿瘤的鉴别诊断。方法收集20例普通子宫平滑肌瘤、20例富细胞性子宫平滑肌瘤、19例子宫平滑肌肉瘤、15例子宫内膜间质内瘤石蜡标本，免疫组化法测定催产素受体、CD10、重型钙调蛋白结合蛋白、平滑肌肌动蛋白、结蛋白以及组蛋白去乙酰化酶8在其中的表达。结果在20例正常及子宫内膜异位症子宫标本中，催产素受体在子宫肌层表达呈强阳性，并且在增殖晚期及排卵期于子宫内膜表面上皮中显著表达，而在子宫内膜间质中无表达。所有普通子宫平滑肌瘤及富细胞性子宫平滑肌瘤标本中催产素表达均呈阳性，子宫平滑肌肉瘤组12例催产素呈强阳性表达，7例催产素呈弱阳性表达。除平滑肌分化区外，所有子宫内膜间质肉瘤标本中催产素表达均为阴性。CD10在所有子宫内膜间质肉瘤标本中呈阳性表达，而普通平滑肌瘤组2例、富于细胞子宫平滑肌瘤组12例、子宫平滑肌肉瘤组12例阳性表达。组重型钙调结合蛋白表达阴性，结蛋白主要表达于平滑肌化生区。除2例呈上皮样表现的子宫平滑肌肉瘤标本中重型钙调结合蛋白表达呈阴性外。重型钙调结合蛋白、平滑肌肌动蛋白以及结蛋白在普通平滑肌瘤组、富于细胞平滑肌瘤组及平滑肌肉瘤组均呈阳性表达。组蛋白去乙酰化酶8在绝大部分子宫平滑肌肿瘤中呈阳性表达，在子宫内膜间质肉瘤中无表达，但子宫平滑肌肉瘤组中有3例组蛋白去乙酰化酶8表达阳性。结论本研究提示催产素受体在子宫平滑肌肿瘤与子宫内膜间质肉瘤中的表达有差异，可作为鉴别两种肿瘤的免疫标记物。

Objective To investigate oxytocin receptor（OTR） expression in the normal uterus, and particularly in uterine smooth muscle tumors and endometrial stromal sarcomas, thus to explore the role of its expression in distinguishing those diseases. Methods The expressions of OTR, CD10, h - ealdesmon, smooth muscle aetin, desmin and HDAC8 were analyzed in 20 conventional leiomyomas（LMs） ,20 highly eeUular leiomyonms（HCLs）, 19 leiomyosareomas（LMSs）, and 15 ESSs. Results In 20 norreal uteri or adenomyosis, OTR was strongly expressed in the myometrium and showed expression pronounced in the surface epithelium during the late proliferative phase and at the time of ovulation, whereas the endometrial stromal cells were negative. All LMs and HCLs were strongly positive for OTR. Twelve eases of LMS showed strong OTR expression in 100% of the tumor cells,whereas seven eases were weakly positive in 10% - 20% of the tumor cells. Every ESS was negative for OTR,exeept in regions of smooth muscle differentiation. All ESSs were positive for CD10, as were two LM, twelve HCLs, and twelve LMSs. The ESSs were negative for h - cnldesmon and showed desmin positivity mainly in re^ons of smooth muscle metaplasia, h - Caldesmon, smooth muscle aetin and desmin were expressed in all LMs, HCLs, and LMSs except for two leiomyosareomas with epithelioid features, which was negative for h-caldesmon. HDAC8 showed positive in most uterine smooth muscle tumors and negative in ESSs, except for three LMSs. Conclusion The present study indicates that the evaluation of OTR expression is useful in the distinction of uterine smooth muscle tumors from ESSs.