口服大剂量米非司酮对子宫内膜癌细胞形态学和免疫组织化学的影响

The morphological and immunohistochemical changes of endometrial carcinoma after high dose mifepriston treatment.

目的 :研究大剂量米非司酮对子宫内膜癌的治疗作用 ,探讨其作用机制。方法 :未治疗的子宫内膜癌患者 12例口服大剂量米非司酮 10 0mg d ,共 5天 ,第 6天手术。在光学显微镜下观察米非司酮治疗前后子宫内膜癌组织学的变化 ,用免疫组化LSAB法检测治疗前后内膜癌组织PCNA、bcl 2、bax表达的改变。结果 :米非司酮治疗后内膜呈黄素化表现 ,柱状上皮由多层变为单层。细胞体积变大 ,胞浆嗜伊红染色加深。胞核变大、变圆 ,染色质疏松 ,核仁出现。细胞增生指数 (PI)明显减少 (P <0 .0 0 5 )。凋亡抑制基因bcl 2表达明显减少 (P <0 .0 0 0 0 5 ) ;凋亡诱导基因bax表达明显增多 (P <0 .0 1)。结论 :米非司酮可能有治疗或预防子宫内膜癌的作用 。

Objective:To investigate the effect of high dose mifepristone treatment in patients with endometrial carcinoma and to explore the possible mechanisms associating with this effect.Methods:Twelve untreated patients with endometrial carcinoma were given high dose mifepristone (100mg/d) for every case for 5 days.On the sixth day,the patient underwent operation.The endometrial carcinoma specimens,include the one before administration of high dose mifepristone,were evaluated for histological and immunohistochemistry assay.Hematoxylin and eosin stained paraffin sections were evaluated for histological morphological changes.Immunohistochemistry assay (LSAB method) was applied to determine the localization and immunoreactivity intensity of PCNA,bcl 2,bax on paraffin embedded sections.Results: After administration of high dose mifepristone,there were remarkable histological changes.The glandular structure was characterized by simple columnar epithelia in stead of stratified columnar epithelium.Cytoplasm eosin staining was more intense than that of before administration one.Nuclei were round and large.Hematoxylin staining was weak with clear nucleoli whereas pre treatment samples were slim.Hematoxylin staining was more intenes than that of before administration one.Nuclei were round and large,hematoxylin staining was strong with no nucleolus or obscure nucleoli.PI(proliferative index) was significantly reduced than pre administration sections (P<0.005).Expression of bcl 2 was less intense than that of pre administration sections (P<0.0005).There was remarkable increment of bax immunostaining (P<0.01) after administrated mifepristone. Conclusions:High dose mifepristone can exert antineoplastic effect on patients with endometrial carcinoma by mechanisms both inhibition of the growth and promotion of apoptosis of endometrial carcinoma.