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目的探讨绝经前、后子宫内膜息肉(EP)的病理特征及其与子宫内膜癌发生的可能关系。方法选取河北医科大学第二医院2006年12月至2007年8月73例经病理证实的宫腔镜直视下电切的EP标本,常规石蜡切片,行HE染色、Masson染色和p53、Ki67蛋白免疫组化染色(ElivisionTM plus两步法)。对照组选取同期正常增生期子宫内膜16例,正常分泌期内膜9例,老年性萎缩内膜9例。对两组标本予以观察。结果 (1)绝经前、后EP腺体形态不同,间质变化类似。(2)绝经后和绝经前分泌型EP均Ki-67阴性表达;绝经前增殖型EP Ki-67标记指数低于正常增生期内膜(P=0.000),阳性表达率差异无统计学意义(P=0.108)。(3)p53弱阳性表达于各型EP,表达阳性率差异无统计学意义(P=0.575);在增殖型EP与绝经后EP,可见部分腺上皮p53蛋白阳性表达强度增高。p53阳性表达率增殖型EP与增生期内膜相比差异无统计学意义(P=0.363),分泌型EP较增殖型EP低(P=0.018),绝经后EP明显高于老年萎缩内膜(P=0.009)。结论 (1)厚壁血管的形成可能与EP发生的关系密切。(2)不同组织类型EP的发生机制可能不同,增殖型EP和绝经后EP组织内部分p53表达增强腺体有可能成为EP癌变的起始点。
Objective To investigate the pathological features of endometrial polyps (EP) before and after menopause and its possible relationship with the occurrence of endometrial cancer. Methods From October 2006 to August 2007, 73 patients with histopathologically confirmed hysteroscopic EP were examined by conventional paraffin sections. HE staining, Masson staining, p53, Ki67 protein Immunohistochemical staining (ElivisionTM plus two-step method). The control group selected the same period of normal proliferative endometrium in 16 cases, 9 cases of normal secretory endometrium, 9 cases of senile atrophy intima. Two groups of specimens were observed. Results (1) Before and after menopause, the morphology of EP gland was different and the interstitial changes were similar. (2) The expression of Ki-67 in postmenopausal and pre-menopausal secretory EP was lower than that in normal proliferative endometrium (P = 0.000). The positive expression rate of EP Ki-67 was not significantly different P = 0.108). (3) There was no significant difference in the expression of p53 in each type of EP (P = 0.575). In proliferating type EP and postmenopausal EP, the expression of p53 protein in some glandular epithelial cells was increased. The positive rate of p53 was not significantly different from that of proliferative endometrium (P = 0.363), while the level of secreting EP was lower than that of proliferating EP (P = 0.018). The postmenopausal EP was significantly higher than that of the atrophic endometrium P = 0.009). Conclusion (1) The formation of thick-walled vessels may be closely related to the occurrence of EP. (2) The mechanism of occurrence of EP in different tissue types may be different. Increased p53 expression in proliferating EP and postmenopausal EP tissues may be the starting point of carcinogenesis of EP.