P16在恶性潜能未定子宫平滑肌肿瘤中的表达及意义

Expression and clinical significance of P16 protein in smooth muscle tumor of uncertain malignant potential

目的探讨在P16在恶性潜能未定子宫平滑肌肿瘤(STUMP)中的表达及意义。方法采用免疫组织化学二步法检测8例STUMP患者,并随机选取15例平滑肌肉瘤(LMS)、23例平滑肌瘤(L)患者和10名正常子宫平滑肌层者,检测三者的P16的共表达情况,与STUMP的免疫组织化学结果相对照。结果 3例最初诊断STUMP的病例发生转移,其中2例弥漫强阳性表达P16。组织学上,这2例均可见不确定性肿瘤细胞性坏死(凝固性坏死或玻璃样变)并且具有轻度细胞学非典型性。15例LMS中12例弥漫强阳性表达P16,3例L局灶表达P16。正常肌层不表达P16。结论在不确定坏死的STUMP诊断中,联合检测P16可以帮助区分STUMP和LMS。

Objective To explore the expression and the clinical significance of P16 in smooth muscle tumor of uncertain malignant potential （STUMP）. Methods Composed of 15 leiomyosarcoma （LMS）, 8 STUMP, 23 leiomyoma （L）, and 10 samples of normal myometrium, P16 expression was correlated with clinical outcome and histological features. Results Three of the tumors originally classified as STUMP developed metastatic disease and 2 of these tumors were strong, diffuse P16 positive. Histologically, these 2 cases were uncertain （eoagulative tumor cell vs hyalinized）, and only mild cytologic atypia. P16 is preferentially expressed in LMS with only rare L showing positivity. Histologically, tumors with eoagulative tumor cell necrosis alone were clinically LMS. Twelve of the 15 LMS strongly and diffusely expressed P16, 3 of the L had focal P16 staining, and none of the normal myometria was P16 positive. Conclusion In those cases in which the type of necrosis is uncertain （eoagulative tumor cell vs hyalinized）, the application of P16 may help distinguish STUMP from LMS.