宫颈管型腺癌的人乳头瘤病毒感染及p16和孕激素受体的染色特征

p16 and PR immunoreactivity and human papillomavirus infection in endocervical adenocarcinoma

目的探讨宫颈管型腺癌的人乳头瘤病毒（HPV）感染情况及其p16和孕激素受体（PR）染色特征。方法收集中国医学科学院肿瘤医院2005年1月至2010年12月宫颈管型腺癌的蜡块62例，进行三明治切片，采用SPF-10 PCR对蜡卷进行HPV DNA的检测和分型，采用免疫组化SP法对p16和PR进行染色。结果62例宫颈管型腺癌中，HPV阳性46例，阳性率为74．2％；其中4例合并宫颈鳞状上皮内瘤变3级者均HPV阳性。46例HPV阳性病例中，HPV18型单一型别感染22例，占全部HPV阳性患者的47．8％；HPV16型14例，占全部HPV阳性患者的30．4％；HPV59型1例，占全部HPV阳性患者的2．2％；多重感染9例，占全部HPV阳性患者的19．6％。16例HPV阴性者的年龄为（49．6±10．5）岁，46例HPV阳性者的年龄为（42．8±9．7）岁，差异有统计学意义（P=0．022）。p16染色阳性率为80．6％。p16染色结果和HPV检测结果显示，2种方法的检测结果无关联性（P=0．077）。PR染色阳性率为3．2％。肿瘤周围可见残存正常宫颈管腺体24例，其中正常宫颈管腺体PR阳性19例，阳性率为79．2％。肿瘤性腺体和正常宫颈管腺体的PR阳性率比较，差异有统计学意义（P〈0．001）。结论宫颈管型腺癌HPV感染率为74．2％，主要为HPV16型和HPV18型。p16染色阳性尚不能说明宫颈管型腺癌具有高危型HPV感染。PR染色结果可以作为鉴别诊断肿瘤性腺体和正常颈管腺体的参考指标之一。

Objective The aim of this study was to investigate the characteristics of p16 and PR immunoreactivity and HPV infection in endocervical adenocarcinoma. Methods Paraffin blocks of 62 patients with endocervical adnocarcinoma treated in the Cancer Institute and Hospital, Chinese Academy of Medical Sciences from year 2005 to year 2010 were collected, p16 and PR immunostaining and HPV detecting by SPF-10 PCR were conducted on all cases. Results HPV infection rate of the 62 endocervical adnocarcinoma cases was 74.2% with four cases combined with CIN3. Among the 46 HPV-positive cases, there were 22 cases of HPV18 infection （47.8%）, 14 cases of HPV16 infection （30.4%）, one case of HPV59 infection （2.2%）. and nine multiple HPV infection cases （ 19.6% ）. The mean age of the 16 HPV-negative cases was （49.6 ± 10.5）year,while the mean age of the 46 HPV-positive cases was （42.8 ± 9.7 ）year, showing a significant difference between the two subgroups （P = 0. 022）. The positive rate of p16 infection was 80.6%. Association analysis showed that the results of p16 and HPV test were independent to each other （P = 0. 077）. The positive rate of PR was 3.2%. Among the 62 cases, there were 24 cases containing normal cervical glands, with 19 cases PR-positive in the normal cervical glands and the positive rate was 79.2%. The difference of PR positivity between neoplastic glands and normal glands was statistically significant by Chi-square test（P 〈 0.01 ）. Conclusions The HPV infection rate of endocervical adnocarcinoma is 74.2%, and the major subtypes were HPV16 and HPV18 infection, p16 immunoreactivity in endocervical adenocarcinoma maybe not the proof of high-risk HPV-related neoplasm. PR staining can be used as a reference designator to differentiate between neoplastic and normal cervical glands.