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目的探讨核仁相关嗜银蛋白(AgNOR)及增殖细胞核抗原(PCNA)的表达在卵巢子宫内膜异位症癌变过程中的意义。方法应用免疫组化法和AgNOR染色检测1986年1月至2006年8月浙江大学医学院附属妇产科医院收治的30例卵巢子宫内膜异位症患者的子宫内膜异位组织、15例卵巢异位子宫内膜腺上皮不典型增生组织、30例卵巢子宫内膜异位症癌变组织中PCNA的表达及AgNOR评分。结果癌变组及不典型增生组AgNOR评分和PCNA评分[分别为5.64±0.15和(49.22±3.97)%;4.37±0.20和(34.66±2.11)%]显著高于子宫内膜异位症组[1.04±0.26;(12.17±2.89)%];癌变组AgNOR和PCNA评分显著高于不典型增生组,P均<0.05。癌变组内AgNOR和PCNA评分比较结果显示:癌变区>移形区>子宫内膜异位症区;不典型增生组内结果显示:不典型区>子宫内膜异位症区(P<0.05)。AgNOR和PCNA评分与肿瘤期别显著相关(P<0.05)。AgNOR评分>5.64和PCNA评分>49.22%的患者预后明显差于AgNOR评分<5.64和PCNA评分<49.22%者(P<0.05)。结论AgNOR及PCNA评分在鉴别子宫内膜异位症良恶性肿瘤及在判定肿瘤期别中起一定的作用;细胞增殖参数可能有助于对子宫内膜异位症癌变预后的判断;部分子宫内膜异位症和不典型增生可能是卵巢癌的癌前病变。
Objective To investigate the significance of the expressions of nucleolar amyloid protein (AgNOR) and proliferating cell nuclear antigen (PCNA) in the carcinogenesis of ovarian endometriosis. Methods Immunohistochemical staining and AgNOR staining were used to detect endometriosis in 30 cases of ovarian endometriosis admitted to Obstetrics and Gynecology Hospital of Zhejiang University from January 1986 to August 2006, The expression of PCNA in 30 cases of ovarian endometriosis cancerous tissue and AgNOR score in 30 cases of ovarian endometriosis. Results The AgNOR score and PCNA score of the cancerous and atypical hyperplasia groups were 5.64 ± 0.15 and 49.22 ± 3.97%, respectively; 4.37 ± 0.20 and 34.66 ± 2.11%, respectively, which were significantly higher than those of the endometriosis group [1.04 ± 0.26; (12.17 ± 2.89)%]. The scores of AgNOR and PCNA in canceration group were significantly higher than those in atypical hyperplasia group (all P <0.05). The results of AgNOR and PCNA score in canceration group showed that canceration> migration> endometriosis, and atypical hyperplasia showed: atypical> endometriosis (P <0.05) . AgNOR and PCNA scores were significantly correlated with tumor stage (P <0.05). The prognosis of patients with AgNOR score> 5.64 and PCNA score> 49.22% was significantly lower than those with AgNOR score <5.64 and PCNA score <49.22% (P <0.05). Conclusion AgNOR and PCNA score in the differential diagnosis of benign and malignant endometriosis and in determining the tumor stage play a role; cell proliferation parameters may contribute to the prognosis of endometriosis prognosis; part of the uterus Membrane dysplasia and dysplasia may be precancerous lesions of ovarian cancer.