胃粘膜癌前病变免疫组化和电镜研究

Immunohistochemical and electromicroscopy study on precancerous lesions of stomach

目的： 研究胃粘膜上皮异型增生（ＧＥＤ） 与肠上皮化生（ＩＭ） 之间及其与胃癌之间的关系。方法： 选择收集胃镜下具有隆起病变特点的人胃粘膜活检２６ 例， 采用光镜、免疫组化染色以及电镜观察等多种手段观察胃粘膜病变的不同阶段的病理变化。结果：２６ 例人胃镜活检组织的不同程度的ＧＥＤ和胃癌中，ｐ５３ 与ｒａｓ ｐ２１ 相伴随表达； ８ 例Ａｔｙｐｉａ ０ － ＩＩＩ的ＧＥＤ中，ｐ５３ 阳性５ 例，ｒａｓ ｐ２１ 阳性３ 例；１７ 例ＧＥＤ异型上皮分型，９ 例Ａｔｙｐｉａ ０－ Ⅰ、Ⅱ全部是胃表面上皮型，８ 例Ａｔｙｐｉａ０－ＩＩＩ中只有２ 例是胃表面上皮型， 经四格表Ｘ２ 检验两者差异显著； 电镜观察可见异型上皮细胞异型性介于癌与正常细胞之间， 有的胞浆有粘液颗粒并同时在细胞之间有丰富的微绒毛。结论： （１） ｐ５３ 与ｒａｓｐ２１在ＧＥＤ和胃癌中相伴随表达， 是参与早期癌变的重要基因； ＧＥＤ是重要的胃癌前病变；（２） ＧＥＤ来源于胃型上皮， 在癌变及演进过程中， 逐渐显示肠型特点， 为肿瘤异质性表现。

Purpose:To detect the inter-relationship of gastric epithelial dysplasia(GED) and intestinal metaplasia(IM),and gastric carcinoma.Method:Twenty-six specimens of gastric endoscope biopsy were examined histologically,immunohistochemically and ultrastructurelly.Result:Twenty-six specimens were GED of different grade and gastric carcinoma.p53 and ras p21 were positive concomitantly in them.In 8 cases of GED with Atypia 0-III,p53 and ras p21 were expressed in 5 and 3 cases respectively.In 17 cases of GED,9 of Atypia 0-I and II were all gastric type,but only two of remained 8 Atypia 0-III cases were gastric type.There was significant difference between them.The ultrastructural appearance of GED showed the intermediate state between normal and carcinoma cell. Conclusion:(1)p53 and ras p21 are important gene which participate in the early stage of carcinogenesis.GED of Atypia 0-III is important precancerous lesion;(2)GED are derived from gastric type epithelia,the atypical epithelia are gradually transformed to intestinal type with the progression of carcinogenesis.It is suggested that not only cancer but also precancerous lesions may be heterogeneous.