子宫内膜息肉73例临床病理分析

Clinicopathological analysis of 73 cases endometrial polyps after hysteroscopy

目的探讨绝经前、后子宫内膜息肉(EP)的病理特征及其与子宫内膜癌发生的可能关系。方法选取河北医科大学第二医院2006年12月至2007年8月73例经病理证实的宫腔镜直视下电切的EP标本,常规石蜡切片,行HE染色、Masson染色和p53、Ki67蛋白免疫组化染色(ElivisionTM plus两步法)。对照组选取同期正常增生期子宫内膜16例,正常分泌期内膜9例,老年性萎缩内膜9例。对两组标本予以观察。结果 (1)绝经前、后EP腺体形态不同,间质变化类似。(2)绝经后和绝经前分泌型EP均Ki-67阴性表达;绝经前增殖型EP Ki-67标记指数低于正常增生期内膜(P=0.000),阳性表达率差异无统计学意义(P=0.108)。(3)p53弱阳性表达于各型EP,表达阳性率差异无统计学意义(P=0.575);在增殖型EP与绝经后EP,可见部分腺上皮p53蛋白阳性表达强度增高。p53阳性表达率增殖型EP与增生期内膜相比差异无统计学意义(P=0.363),分泌型EP较增殖型EP低(P=0.018),绝经后EP明显高于老年萎缩内膜(P=0.009)。结论 (1)厚壁血管的形成可能与EP发生的关系密切。(2)不同组织类型EP的发生机制可能不同,增殖型EP和绝经后EP组织内部分p53表达增强腺体有可能成为EP癌变的起始点。

Objective To comparative analysis the pathological characteristics between premenopausal endometrial polyps and postmenopausal endometrial polyps, and to explore the possible relationship between endometrial polyps and endometrial carcinoma. Methods 73 cases of endometrial polyps after hysteroscopy were observed by HE staining, MASSON staining, and immunohistochemical study with Elivision^TM plus two-step method were used to observe the expression of Ki- 67 and p53 protein mutations in endometrial polyps. The experimental data were statistically analyzed with SPSS 13.0 edition. Results （ 1 ） The morphological feature of glands between post- and premenopausal endometrial polyps was different. （2）For proliferative endometrial polyps, the mean values of Ki-67LI were significantly higher than for normal proliferative endometrium （P = 0. 000）. （3）The expression of p53 protein in all types of endometfial polyps were weak positive expression. Higher expression of p53 protein could be observed in some glands in proliferative endometfial polyps and postmenopausal endometrial polyps. There were no differences in the positive expression rate of p53 protein between in proliferative EP and in proliferative endometrium （ P = 0. 363 ）. The positive expression rate of p53 protein m secretory EP was significantly lower than in proliferative EP （P = 0. 018 ）. The positive expression rate of p53 protein in postmeno- pausal EP was significantly higher than in senile endometrium （ P = 0. 009 ）. Conclusion （ 1 ） The formation of thickwalled arteries maybe close relations with the occurrence of endometrial polyps. （ 2 ） The occurrence mechanism of different types of endometrial polyps maybe various, The initial cancer of endometfial polyps maybe come from the glands which had higher expression of p53 protein in proliferative endometrial polyps and postmenopausal endometrial polyps.