Nandan Ruchira, Jain Vishesh, Agarwala Sandeep, Das Prasenjit, Goel Prabudh, Kalaivani Mani, Yadav Devendra Kumar
Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
J Indian Assoc Pediatr Surg. 2022 Jul-Aug;27(4):395-401. doi: 10.4103/jiaps.jiaps_103_21. Epub 2022 Jul 26.
The etiopathogenesis of pelviureteric junction obstruction (PUJO) has been debated. Recently, the role of interstitial cells of Cajal-like cells (ICC-LC)has been studied and reported to be the cause of this functional obstruction. We studied the histopathology and ICC-LC density at PUJ and compared it with that of PUJ of the control group and distal ureteric margin of the study group.
A prospective study was conducted which included PUJO patients in the study group and the renal tumor patients in the control group. Histopathological examination (muscle hypertrophy and fibrosis) and immunohistochemistry (ICC-LC density) were done. The muscle hypertrophy, fibrosis, and ICC-LC density at the PUJ in both the groups were compared. A similar comparison was performed between the findings at the PUJ and the distal margin in the study group.
The study and control groups included 37 PUJO patients and 13 Wilms tumor patients. The ICC-LC density at PUJ in the study group was significantly lower than that in the control group ( < 0.001) and that at the distal resected margin of the study group ( < 0.001). Significantly increased muscle hypertrophy ( < 0.001) and fibrosis ( = 0.002) were seen at PUJ in the study group compared to the control group. No significant association was noted between the ICC-LC density and muscle hypertrophy at PUJ and the distal resected margin in the study group.
A significant decrease in the density of ICC-LC and increased fibrosis and muscle hypertrophy at PUJ in children with PUJO play a role in the etiopathogenesis of the disease.
肾盂输尿管连接部梗阻（PUJO）的病因发病机制一直存在争议。最近，对 Cajal 样间质细胞（ICC-LC）的作用进行了研究，并报告其为这种功能性梗阻的原因。我们研究了肾盂输尿管连接部的组织病理学和 ICC-LC 密度，并将其与对照组的肾盂输尿管连接部以及研究组的输尿管远端切缘进行比较。
进行了一项前瞻性研究，研究组纳入 PUJO 患者，对照组纳入肾肿瘤患者。进行了组织病理学检查（肌肉肥大和纤维化）和免疫组织化学检查（ICC-LC 密度）。比较了两组肾盂输尿管连接部的肌肉肥大、纤维化和 ICC-LC 密度。对研究组中肾盂输尿管连接部和远端切缘的结果进行了类似比较。
研究组和对照组分别包括 37 例 PUJO 患者和 13 例肾母细胞瘤患者。研究组肾盂输尿管连接部的 ICC-LC 密度显著低于对照组（<0.001）以及研究组输尿管远端切除切缘的 ICC-LC 密度（<0.001）。与对照组相比，研究组肾盂输尿管连接部的肌肉肥大（<0.001）和纤维化（=0.002）显著增加。研究组中肾盂输尿管连接部和远端切除切缘的 ICC-LC 密度与肌肉肥大之间未发现显著关联。
PUJO 患儿肾盂输尿管连接部 ICC-LC 密度显著降低以及纤维化和肌肉肥大增加在该疾病的病因发病机制中起作用。
