喉鳞癌癌旁组织超微结构特点透射电镜研究

Observation of pericarcinoma ultrastructure in laryngeal squamous carcinoma by transmission electron microscopy

目的：为喉癌手术安全缘的界定提供超微结构形态学支持。方法：通过透射电镜、光镜,结合免疫组化方法对6例癌旁（距肉眼癌灶边缘3、4、5 mm）声带组织的各层结构及p53、Ki-67抗原表达进行观察。结果：电镜下上皮层细胞均有不同程度的异型性改变,具有肿瘤细胞特点,表现为细胞形态、大小不一,细胞核大,染色质边集以及细胞器的堆积和异位;任克氏层内可见新生血管及血管内凝血现象,炎症反应明显,距癌灶边缘3 mm标本任克氏层或声韧带内可见肿瘤细胞,形态特点与上皮内肿瘤细胞特点一致;声韧带与声带肌交界处未见肿瘤相关形态学改变。光镜下距癌灶边缘3 mm标本为浸润性鳞癌,4 mm为上皮内瘤变Ⅱ~Ⅲ级,5 mm为上皮内瘤变Ⅰ~Ⅱ级;免疫组化研究p53、Ki-67分别为中阳性、弱阳性、阴性。结论：手术切除肿物是喉癌的主要治疗手段。手术安全缘处癌旁组织仍具异型性,如依据3 mm手术安全缘进行喉部分切除手术,难以排除术后复发的风险。

Objective： To provide ultrastructure morphological support for surgical security margin of laryngeal carcinoma.Methods： The pericarcinoma ultrastructure on 6 specimens of pericarcinoma vocal fold tissue（the distance away from the carcinoma margin under naked eyes were 3 mm,4 mm,5 mm） and expression of p53 and Ki-67 in laryngeal squamous carcinoma were observed by transmission electron microscopy（TEM）,microscope and immunohistochemistry.Results： Under the TEM,the atypia of the epithelial cell in the pericarcinoma vocal fold tissue were dramatic and in different stages,and had the typical changes of the carcinoma cells,like the differentiation of the morphology and the size of the cells,the enlargement of the nucleus,the accumulation and ectopia of the organelles.The neovascularization,intravascular coagulation and the inflammatory reaction could be observed in the Reinke ’ s space.The tumor cells could be observed in the Reinke ’ s space or vocal fold ligament（3 mm away from the carcinoma margin）,and had the same feature with the tumor cells in the epithelia.There were no positive results in the junction between the ligament and vocalis.Under the microscope,invasive squamous cell carcinoma（3 mm away from the carcinoma margin）,intraepithelial neoplasiaⅡ~Ⅲ（4 mm away）,intraepithelial neoplasia Ⅰ~Ⅱ（5 mm away） were observed.The results of the immunohistochemistry of p53 and Ki-67 were moderately positive,weak positive and negative.Conclusion： The surgical resection of the cancer is an important treatment for laryngeal carcinoma.The atypia of the pericarcinoma tissues are remarkable.So the recurrence maybe occurr after partial laryngectomy according to the 3 mm surgical security margin.