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目的探讨宫颈腺癌中胰岛素样生长因子ⅡmRNA结合蛋白(IMP3)和p16INK4a蛋白的表达及意义。方法运用免疫组化SP法观察IMP3和En Vision法观察p16INK4a在宫颈25例良性腺上皮(BEG)、10例原位腺癌(AIS)和50例浸润性腺癌(ECA)中的表达,同时随机选取IMP3不同程度阳性表达病例25例进行IMP3 mRNA原位杂交检测。结果 IMP3在BEG、AIS和ECA中阳性率分别为16%(4/25)、90%(9/10)和78%(39/50),差异显著(P<0.01);p16INK4a阳性率分别为0(0/25)、100%(10/10)和82%(41/50),差异显著(P<0.01)。ECA中,IMP3和p16INK4a在浆液性腺癌中的阳性率(均为100%,3/3)均高于宫颈型(76.19%,32/42和83.33%,35/42)和子宫内膜样型(80%,4/5和60%,3/5);腺癌中,IMP3在高分化腺癌与中-低分化腺癌中的阳性率比较差异显著(P<0.05)。IMP3和p16INK4a分别在不同年龄、组织学类型及FIGO分期中表达差异均不显著(P>0.05)。ECA中,IMP3和p16INK4a共同阳性率为64%(32/50),阴性率4%(2/50),两者表达的关联性较低(Kappa值为0.002,P>0.05)。结论 IMP3和p16INK4a在宫颈腺上皮的良、恶性病变鉴别诊断中有重要参考价值,IMP3表达与肿瘤分化程度相关;IMP3和p16INK4a联合运用可辅助临床ECA的诊断。
Objective To investigate the expression and significance of insulin-like growth factor Ⅱ mRNA (IMP3) and p16INK4a protein in cervical adenocarcinoma. Methods The expression of p16INK4a in 25 cases of benign glandular epithelium (BEG), 10 cases of adenocarcinoma of the invagination (AIS) and 50 cases of invasive adenocarcinoma (ECA) was observed by immunohistochemical SP method. Twenty-five cases of IMP3 positive expression were selected for IMP3 mRNA in situ hybridization. Results The positive rates of IMP3 in BEG, AIS and ECA were 16% (4/25), 90% (9/10) and 78% (39/50) respectively, with significant difference (P <0.01). The positive rates of p16INK4a were 0 (0/25), 100% (10/10) and 82% (41/50) respectively, with significant difference (P <0.01). In ECA, the positive rate of IMP3 and p16INK4a in serous adenocarcinoma was higher than that of cervical type (76.19%, 32/42 and 83.33%, 35/42) and endometrial type (all 100%, 3/3) (80%, 4/5 and 60%, 3/5). The positive rate of IMP3 in well-differentiated and moderately-poorly differentiated adenocarcinomas was significantly different between adenocarcinoma and adenocarcinoma (P <0.05). There was no significant difference in the expression of IMP3 and p16INK4a between different age, histological type and FIGO stage (P> 0.05). In ECA, the positive rate of IMP3 and p16INK4a was 64% (32/50), the negative rate was 4% (2/50). The correlation between the expression of IMP3 and p16INK4a was low (Kappa = 0.002, P> 0.05). Conclusion The expression of IMP3 and p16INK4a may be valuable in the differential diagnosis of benign and malignant lesions of cervical gland epithelium. The expression of IMP3 correlates with the degree of tumor differentiation. Combined use of IMP3 and p16INK4a may aid in the diagnosis of clinical ECA.