【作者】 陈旭；

【导师】 周之海； 倪海洋；

【作者基本信息】 天津医科大学 ， 皮肤病与性病学， 2008， 硕士

【摘要】 回顾天津医科大学总医院皮肤科门诊病理室病历资料,了解非良性皮肤肿瘤的发病情况。收集、统计和分析1980年1月至2007年9月天津医科大学总医院皮肤科经病理诊断的非良性皮肤肿瘤的临床资料。共纳入非良性皮肤肿瘤患者531例,男302例,女229例;表皮来源的非良性肿瘤共计414例,占全部的77.97%;主要6种肿瘤的性别构成存在显著差异,皮肤佩吉特病两性患者数量差别最为显著;恶性黑色素瘤患者年龄数据离散程度(四分位数间距32.25)最高,年龄最小患者13岁。非良性皮肤肿瘤和恶性皮肤肿瘤的年诊断例数呈增加的趋势。表皮来源肿瘤是主要的非良性皮肤肿瘤。乳腺外佩吉特病(Extramammary Paget’s disease,EMPD)的好发性别,在国人与白色人种之间存在明显差别。警惕恶性黑色素瘤在青少年患者中的发生。通过检测粘蛋白的表达水平,探索EMPD的肿瘤生物学特性。包括探讨该肿瘤可能的来源;粘蛋白在该肿瘤中的异常表达是否具有特异性,黏蛋白的表达与EMPD淋巴转移的关系。分析E-钙黏蛋白在EMPD中的表达情况,探讨该肿瘤细胞的侵袭转移机制。检测端粒酶在该肿瘤中的活性。采用常规组织病理技术、HE染色、免疫组织化学染色和原位杂交技术。实验数据通过统计分析,发现MUC5AC和E—钙黏蛋白在病例组和对照组中表达存在明显差异。32例患者中有25例表达MUC5AC;E—钙黏蛋白在对照组中全部11例表皮弥漫性表达,但着色强度存在一定差异。而病例组中该蛋白相较对照组存在明显的表达下降,主要表现为染色强度降低,部分病例出现巢状的E—钙黏蛋白表达缺失。本研究中黏蛋白、E—钙黏蛋白的表达、Tert活性与淋巴转移的出现与否、MUC1表达与E—钙黏蛋白表达之间、黏蛋白、E—钙黏蛋白的表达与Tert活性之间没有发现存在关联性。推测MUC5AC在EMPD是一种具有较高特异性的肿瘤标志蛋白。EMPD的肿瘤细胞可能来源于基底细胞层的表皮干细胞。E—钙黏蛋白的在EMPD肿瘤细胞的生长过程中具有重要的生物学意义,这种蛋白的表达下调可能导致了肿瘤的逐渐弥漫性生长。黏蛋白、E—钙黏蛋白的表达、Tert活性之间的关系以及它们与淋巴转移的出现与否之间是否存在联系有待于深入研究。更多还原

【Abstract】 To investigate the clinical features and changes in the incidence of non-benign Skin Neoplasms in the Department of Dermatology General Hospital of Tianjin Medical University. The patients diagnosed pathologically as non-benign Skin Neoplasms from Jan 1980 to Sep 2007 were retrospectively retrospected. Clinical data of patients were collected and analyzed by statistical methods. There were 531 patients with non-benign Skin Neoplasms diagnosed from 1980 to 2007, including 302 men and 229 women. 414 non-benign Skin Neoplasms from epidermis took the 77.97% of all cases. Six important kinds of all had obviously difference in gender proportion. The difference of skin Paget’s disease was the most significant. Vicariance of melanoma patient’s age was highest in all cases. The most youngest patient was 13 years. The cases of non-benign and malignant Skin Neoplasms had been increasing in the past 26 years. Neoplasms from epidermis was the main non-benign Skin Neoplasms. There had significant difference in patient gender of extramammary Paget’s disease between Chinese and Caucasian. We should pay close attention to probability which youngsters have melanoma.To analyze the tumor biological character of extramammary Paget’s disease by investigate the expression of mucins. The content of research included the histological source of extramammary Paget’s disease, and specificity of mucins expression in extramammary Paget’s disease, the value in diagnosis and treatment of mucins expression in extramammary Paget’s disease, the relationship of mucins expression and lymphatic metastasis of extramammary Paget’s disease. By analyzing the E-cadherin expression in extramammary Paget’s disease, to discuss the mechanism in invasion and metastasis of Paget’s cell. To investigate the activity of human telomerase reverse transcriptase in extramammary Paget’s disease. The technique of common histological pathology, HE staining, and immunohistochemistry, hybridization in situ were took in our research. The data of experiment was analyze by statistical method. There were significant difference between extramammary Paget’s disease group and contrast group in expression of mucins and E-cadherin. 25 cases of extramammary Paget’s disease group had muc5AC expression. All of contrast group had E-cadherin expression, but they had the different expression intensity. The E-cadherin expression intensity in extramammary Paget’s disease descended significantly than contrast group. Some cases had focus disappearance in epidermis. In our research, there weren’t relation between lymphatic metastasis and expression fo mucins and E-cadherin, between lymphatic metastasis and human telomerase reverse transcriptase activity, between mucl and E-cadherin, between mucins and E-cadherin, between human telomerase reverse transcriptase activity and mucins, between human telomerase reverse transcriptase activity and E-cadherin. Muc5AC maybe one of tumor special protein in extramammary Paget’s disease. Paget ’s cell maybe from epidermis stem cell in basal cell layer. E-cadherin may be as the important character in extramammary Paget’s disease. It’s descending may be the reason of Paget’s cell widespread. The relation between mucins, E-cadherin and human telomerase reverse transcriptase need continue to research, so as the relation between they and lymphatic metastasis.更多还原