【作者】 吴志强；

【导师】 鲁建云；

【作者基本信息】 中南大学 ， 皮肤病与性病学， 2008， 硕士

【摘要】 目的通过对基底细胞癌(Basal cell carcinoma,BCC)皮损中不同标记朗格汉斯细胞(Langerhans cells,LC)特点的研究,了解BCC皮损中LC数量、形态及分布的变化,探讨其在皮肤肿瘤免疫中可能的作用。方法应用免疫组化方法对30例BCC皮损分别进行CD1a、S-100蛋白和HLA-DR阳性LC染色,并以计算机图象分析系统对阳性细胞进行定量研究,同时设鳞状细胞癌、脂溢性角化病及正常人皮肤各15例作为对照组。结果1.朗格汉斯细胞计数:①.CD1a+LC的表达:BCC皮损中CD1a+LC呈局灶性分布于癌巢,细胞形态呈点状或斑状,突起明显减少、缩短甚至消失;CD1a+LC的数量(77.36±21.53个/mm~2)较脂溢性角化病组(334.61±50.3个/mm~2)和正常皮肤组(216.92±48.75个/mm~2)显著下降(P＜0.05),与鳞状细胞癌组(74.29±18.11个/mm~2)相比,组间数量差异无统计学意义(P＞0.05)。②.S-100+LC的表达:BCC皮损中S-100+LC呈弥漫性分布于癌巢和癌旁,细胞染色增强,突起明显增多、增长;S-100+LC的数量(294.48±43.63个/mm~2)较鳞状细胞癌组(79.30±20.58个/mm~2)和正常皮肤组(182.24±33.16个/mm~2)显著增加(P＜0.05),低于脂溢性角化病组(339.51±48.44个/mm~2),差异有统计学意义(P＜0.05)③.HLA-DR+LC的表达:BCC皮损中HLA-DR+LC主要集中于癌旁,细胞形态与对照组相似;HLA-DR+LC的数量(232.12±50.06个/mm~2)较鳞状细胞癌组(226.29±46.83个/mm~2)和正常皮肤组(214.52±45.13个/mm~2)略增加,但差异无统计学意义(P＞0.05);其数量明显低于脂溢性角化病组(340.74±47.28个/mm~2)(P＜0.05)。2.免疫组化定量分析结果显示:BCC皮损组中阳性细胞CD1a的平均灰度值高于脂溢性角化病组和正常皮肤组(P＜0.05),与鳞状细胞癌组相比差异无显著性(P＞0.05);BCC皮损组中阳性细胞S-100蛋白的平均灰度值低于鳞状细胞癌组和正常皮肤组(P＜0.05),而高于脂溢性角化病组(P＜0.05);BCC皮损组中阳性细胞HLA-DR抗原平均灰度值与鳞状细胞癌和正常皮肤组比较差异无显著性(P＞0.05),但高于脂溢性角化病组(P＜0.05)。3.S-100+LC/CD1a+LC比例分析结果显示:30例BCC皮损中S-100+LC/CD1a+LC比值均数为3.89+0.72;15例正常人皮肤中S-100+LC/CD1a+LC比值均数为0.85±0.14,组间差异有统计学意义(P＜0.05)。结论1.BCC皮损中不同标记LC数量、形态及分布趋势各不相同,其中浸润以成熟型DC为主。2.BCC皮损中不同标记LC数量、形态及分布的变化,提示其局部特殊细胞免疫状态;S-100+LC的高表达可能是其低转移性和较好预后的重要原因之一。更多还原

【Abstract】 Objective To analyze some features of differently-labelled Langerhans cells(LC)in the lesions of Basal cell carcinoma(BCC),and to explore the changes of number,morphology and distribution of them and then assess the roles of them in the cutaneous tumor immunity.Methods Immunohistochemistry technique was performed by using antibodies against the cell surface markers CD1a,S-100 protein and HLA-DR,and the positive cells were quantitatively estimated by the computer image analysis system.30 cases of BCC were included in this study,and 15 cases of Squamous cell carcinoma(SCC),15 cases of Seborrheic keratosis(SK)and 15 cases of normal skin were taken as controls,respectively.Results1.Cells-counting of LC:①CD1a-positive LC in BCC were topically observed in tumor nests,they revealed striking morphological changes:a reduced number of dendrites,with short and few branches;the number of CD1a+cells in BCC was significantly lower than in SK and normal skin(P<0.05).②S-100-positive LC were observed even all over the BCC lesions. And S-100+cells displayed a more matured morphology,with longer and more dendrites.The number of LC in BCC was obviously increased compared with SCC and normal skin(P<0.05)③HLA-DR-positive LC were focused by the peritumor area,their morphology were similar to the control;No significant differences were observed in the number of LC among SCC,normal control and BCC group(P>0.05).2.In the quantitative analysis of immunohistochemistry,there were no significant differences in gray density of HLA-DR among SCC, normal control and BCC group(P>0.05).However,the gray density of CD1a- positive cells in BCC group was statistically higher than in SK and normal skin(P<0.05),and the gray density of S-100+LC in BCC was statistically lower than in SCC and normal skin(P<0.05).3.The analysis of S-100+LC/CD1a+LC ratio showed:the ratios of S-100+LC to CD1a+LC in BCC groups were 3.89±0.72,and 0.85±0.14 in normal controls,and there were significant differences between them (P<0.05).Conclusion1.The number,morphology and distribution of differently-labelled Langerhans cells were significantly different in BCC,and the infiltration were mainly mature DC.2.The alterations in numbers,morphology and distribution of differently-labelled LC in the lesions of BCC,were indications of their local cells immune status;the high expression of S-100-positive LC may be one of the important causes of their biological behavior,such as the favorable prognosis and the low metastasis.更多还原