Danilova N V, Andreeva Iu Iu, Zavalishina L É, Mal'kov P G
Arkh Patol. 2012 Jul-Aug;74(4):28-33.
It is very difficult to identify stromal invasion when the glandular epithelium of the cervix uteri is involved. It is necessary to draw a clear distinction between its glandular structures and adenocarcinoma in situ, involving the preexisting crypts and invasive glands. An attempt was made to assess the possibilities of using as markers of invasion the following stromal proteins and adhesion molecules: CD44, E-cadherin, beta-catenin, tenascin, and laminin.
Fifty-three cases of benign glandular changes, 66 cases of dysplasias and adenocarcinomas in situ, and 47 cases of invasive adenocarcinoma were examined. An immunohistochemical study was performed according to the standard protocol using the antibodies to CD44, laminin, tenascin, E-cadherin, and beta-catenin and a semiquantitative assessment of results was made.
CD44 was found to be redistributed from the cells to the tumor stroma. CD44 was not detected in the stroma surrounding the intact glands, so were benign epithelial changes. In the tumor environment, there was, on the contrary, a reaction with CD44 in 74.5% of invasive adenocarcinomas cases (p < 0.05). The expression of tenascin in the invasive adenocarcinomas and around the foci of early stromal invasion significantly exceeded that in the stroma around the intact glands and dysplastic changes (p < 0.05). All the study groups showed a membrane reaction with E-cadherin and beta-catenin, which probably suggested that changes were absent in the Wnt signaling pathway. In 70.2% of invasive adenocarcinomas, laminin demonstrated a significant cytoplasmic expression in 5-30% of the tumor cells predominantly located along the tumor invasion area or in the deepest tumor complexes (p > 0.05).
CD44 and tenascin are of great diagnostic value in examining invasive and microinvasive adenocarcinomas of the cervix uteri. E-cadherin and beta-catenin are of no diagnostic value in the study groups of pathological processes. Laminin is a potential marker of stromal invasion; however, its expression calls for further investigation.
当宫颈腺上皮受累时，很难识别间质浸润。有必要明确区分其腺性结构与原位腺癌，包括既存腺管和浸润性腺管。本研究尝试评估以下间质蛋白和黏附分子作为浸润标志物的可能性：CD44、E-钙黏蛋白、β-连环蛋白、腱生蛋白和层粘连蛋白。
对53例良性腺性改变、66例发育异常和原位腺癌以及47例浸润性腺癌进行检查。按照标准方案，使用针对CD44、层粘连蛋白、腱生蛋白、E-钙黏蛋白和β-连环蛋白的抗体进行免疫组织化学研究，并对结果进行半定量评估。
发现CD44从细胞重新分布至肿瘤间质。在完整腺管周围的间质中未检测到CD44，良性上皮改变中也未检测到。相反，在肿瘤环境中，74.5%的浸润性腺癌病例出现了CD44反应（p < 0.05）。腱生蛋白在浸润性腺癌及早期间质浸润灶周围的表达显著超过完整腺管周围间质和发育异常改变中的表达（p < 0.05）。所有研究组均显示E-钙黏蛋白和β-连环蛋白的膜反应，这可能表明Wnt信号通路未发生改变。在70.2%的浸润性腺癌中，层粘连蛋白在5% - 30%的肿瘤细胞中呈显著的细胞质表达，主要位于肿瘤浸润区域或最深的肿瘤复合体中（p > 0.05）。
CD44和腱生蛋白在宫颈浸润性和微浸润性腺癌检查中具有重要诊断价值。E-钙黏蛋白和β-连环蛋白在病理过程研究组中无诊断价值。层粘连蛋白是间质浸润的潜在标志物；然而，其表达需要进一步研究。
