胆囊腺瘤和腺癌中Survivin与p53的定位表达及病理诊断意义

Expression and pathological diagnosis of Survivin and p53 in adenoma and carcinoma of gallbladder

目的:观察胆囊腺瘤和胆囊腺癌细胞中Survivin与p53蛋白定位表达和形态特征,研究其在病理诊断及鉴别诊断中的意义。方法:采用免疫组化方法(SP法)检测25例胆囊腺瘤和53例胆囊腺癌细胞中Sur-vivin与p53蛋白的表达。结果:25例胆囊腺瘤,23例Survivin蛋白细胞浆内表达,阳性率92%;其中21例核上表达,包括"核上核样"表达17例、"核上泥沙样"表达4例;细胞浆弥漫表达2例;p53蛋白在胆囊腺瘤组织中无表达。53例胆囊腺癌,Survivin蛋白细胞浆弥漫表达,阳性率75.47%;p53蛋白细胞核内表达,核内表达率77.36%。Survivin在胆囊腺瘤和胆囊腺癌中的表达阳性率虽无显著性差异,但表达部位和形态特征显著不同。结论:Survivin在胆囊腺瘤中的"核上核样"和"核上泥沙样"表达,特异性强,有望成为胆囊腺瘤的诊断性抗体;其与p53在胆囊腺癌组织中核阳性表达、胆囊腺瘤组织中无表达这个结果相结合,构成两者在分子形态学表达的差异性,可作为胆囊腺瘤和胆囊腺癌病理鉴别诊断中的一种分子学方法,结合HE切片,基本可解决胆囊腺瘤与胆囊腺癌的病理诊断与鉴别诊断问题。

Objective：To approach the role of Survivin and p53 in diagnosis and differential diagnosis of adenoma and carcinoma of gallbladder by observing the expression, expression location and characteristics of Survivin and p53 in carcinoma and adenoma of gallbladder. Methods ：The expression of Survivin and p53 in carcinoma and adenoma of gallbladder were detected by immunohistochemical SP method. Results：In 25 gallbladder adenoma specimen, tumor cells were reacted characteristically to Survivin in 23 specimen（92% ）, which expressed on the cytoblast in cytoplasm with cytoblast - like 17, sediment - like 4,. expression rate in number 84.00% and cytoplasmic diffusing expression 2 and were completely negative for p53. Immunohistochemical studies demonstrated that in 53 gallbladder carcinoma specimen, tumor cells showed cytoplasmic diffused immunoreactivity for Survivin, expression rate 75.47%, and cytoblastic immunoreactivity for p53, expression rate 77.36%. There was no difference in expression rate,but significantly different in expression location and characteristics between gallbladder carcinoma and gallbladder adenoma. Conclusion ： Survivin was used as a diagnosis antibody of gallbladder adenoma for its characteristical cytoblast - like and sediment - like expression. Immunohistochemical studies demonstrated that in gallbladder carcinoma specimen, tumor cells showed cytoblastic immunoreactivity for p53, and in gallbladder adenoma specimen, were completely negative for p53. It is suggested that there are a molecular methods in the diagnosis and differential diagnosis of carcinoma and adenoma of gallbladder based on the significant difference in molecular morphology expression of Survivin and p53. In combination with HE stain,it can basically solved the diagnosis and differential diagnosis of carcinoma and adenoma of gallbladder.