高级别子宫内膜癌中错配修复蛋白的表达及其临床病理意义

Expression of mismatch repair protein in high-grade diametric cancer and its mythological significance

目的探讨高级别子宫内膜癌(EC)中错配修复蛋白(MMR)缺失率及意义。方法收集2014年6月至2019年10月宁波市临床病理诊断中心诊治的134例高级别EC患者,复阅病理切片再次明确病理诊断、组织学分类和病理学分级。采用免疫组织化学法检测肿瘤细胞MMR蛋白(包括MSH2、MSH6、MLH1和PMS2)的表达,并分析MMR表达与组织学分类的关系。结果 134例高级别EC患者中102例MMR蛋白表达阳性,32例(23.9%),MMR蛋白表达阴性,其中MSH2和/或MSH6阴性12例(9.0%),MLH1和/或PMS2阴性20例(14.9%)。不同组织学类型的高级别EC患者MMR蛋白阴性表达情况如下:EEC 3级20例,CCC 4例,SC 0例,混合性腺癌2例,癌肉瘤2例,未分化癌1例,去分化癌3例。非II高级别型EC患者MMR蛋白阴性率(41.9%)显著高于II型高级别EC患者(8.3%)(P<0.01)。结论在临床工作中碰到组织学类型为非II型高级别EC时,应特别注意检查是否有MMR蛋白缺失性表达,进一步明确其是否具有MMR基因突变,以便进一步作出相应的治疗。

Objective To investigate the loss rate of mismatch repair protein(MMR) in high-grade endometrial cancer(EC) and its clinicopathological significance. Methods A total of 134 high-grade EC patients collected,whose pathological sections were reviewed to confirm the pathological diagnosis, histological classification and pathological graders. The expression of MMR proteins(including MSH2, MSH6, MLH1 and PMS2) in tumor cells was detected by immunohistochemistry, and the relationship between MMR expression and histological classification was analyzed. Results Among 134 high-grade EC patients, 102 were positive for MMR protein, and 32(23.9%)were negative for MMR protein;of which, 12(9.0%) were negative for MSH2 and/or MSH6, and 20(14.9%) were negative for MLH1 and/or PMS2. The negative expression of MMR protein in high-grade EC patients with different histological types was as follows: 20 cases of EEC 3, 4 cases of CCC, 0 case of SC, 2 cases of mixed adenocarcinoma, 2 cases of carcinosarcoma, 1 case of undifferentiated carcinoma, and 3 cases of dedifferentiated cancer. The negative rate of MMR protein in non-II high-grade EC patients was significantly higher than that in type II high-grade EC patients(P< 0.05). Conclusions In the clinical work, when encountering non-type II high-level EC, special attention should be paid to check whether there is a deletion of MMR protein, and to further determine whether it has MMR gene mutations in order to further corresponding treatment.