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Different Expressions of Bcl-2 and Vascular Endothelial Growth Factor Receptor-3 in Intravenous Leiomyomatosis and Classical Leiomyoma
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摘要:
目的 探索bcl-2和血管内皮生长因子受体3(vascular endothelial growth factor receptor-3, VEGFR-3)在子宫静脉内平滑肌瘤病(intravenous leiomyomatosis, IVL)及普通型平滑肌瘤(leiomyoma, LM)中表达的区别。 方法 回顾性分析20例IVL, 并匹配10例LM作为对照, 挑选存档组织块进行bcl-2和VEGFR-3免疫组织化学染色, 分析肿瘤细胞的表达情况并与LM进行对比分析。 结果 20例IVL病例bcl-2免疫组织化学染色全部呈中-强着色, 阳性率100%;VEGFR-3免疫组织化学染色19例呈中-强着色, 1例阴性, 阳性率95%。10例LM的bcl-2免疫组织化学染色均呈弱-中等着色, 阳性率100%;而VEGFR-3免疫组织化学染色则均为阴性, 阳性率为0。 结论 Bcl-2和VEGFR-3在IVL中均呈高表达, 尤其VEGFR-3表达与LM有明显差异, 提示IVL具有与LM不同的分子改变, 而这些分子改变可能在IVL的发生、发展中起重要作用。 -
关键词:
- 子宫静脉内平滑肌瘤病 /
- bcl-2 /
- 血管内皮生长因子受体3 /
- 免疫组织化学染色
Abstract:Objective To explore the different expressions of bcl-2 and vascular endothelial growth factor receptor-3 (VEGFR-3) in intravenous leiomyomatosis (IVL) and classical leiomyoma (LM). Methods We retrospectively reviewed the pathology of 20 cases of IVL, matching with 10 cases of LM. The bcl-2 and VEGFR-3 immunohistochemical staining was performed in the slides from all cases, and the results were compared between the IVL group and LM group. Results In the IVL group, all the 20 cases showed moderate to strong bcl-2 immunohistochemical staining. Meanwhile, 19 cases showed moderate to strong VEGFR-3 immunohistochemical staining, while 1 case was negative. In the LM group, all 10 cases showed weak to moderate bcl-2 immunohistochemical staining and negative VEGFR-3 staining. Conclusions Both bcl-2 and VEGFR-3 are highly expressed in IVL; in particular, the expression of VEGFR-3 is dramatically different between IVL and LM. This indicates IVL and LM have different molecular alterations, which may play important roles in the pathogenesis and development of IVL. -
图 1 静脉内平滑肌瘤病的不同组织学图像
A.低倍显示肿瘤破坏局部静脉壁，进入静脉内呈结节状生长；B.中倍显示肿瘤内部由众多血管腔构成的“海绵状”区域；C.低倍显示呈乳头状生长的区域；D.低倍显示肿瘤中央部出血伴明显退变，仅周边部残留形态尚可的薄层肿瘤细胞；E.中倍显示肿瘤明显黏液变性；F.中倍显示肿瘤中央部明显玻璃样变；G.低倍显示富于细胞型静脉内平滑肌瘤病，其内可见血栓形成；H.中倍显示肿瘤局部呈平滑肌脂肪瘤形态
图 2 Bcl-2和VEGFR-3免疫组织化学染色结果
第一行为IVL病例3，显示强bcl-2染色和中等VEGFR-3染色；第二行为IVL病例9，显示中等bcl-2染色和强VEGFR-3染色；第三行为LM病例，显示弱bcl-2染色和阴性VEGFR-3染色VEGFR-3：血管内皮生长因子受体3；IVL：静脉内平滑肌瘤病；LM：平滑肌瘤
表 1 20例静脉内平滑肌瘤病患者的临床病理特征
病例 性别 年龄(岁) 最大径(cm) 累及范围 形态特点 1 女 43 10 盆腔、下腔静脉 黏液变性、脂肪组织 2 女 51 3.5 宫旁静脉 玻璃样变、脂肪组织 3 女 41 7 右髂静脉及下腔静脉 黏液变性 4 女 56 2.2 宫旁静脉 玻璃样变 5 女 55 7 宫旁静脉及卵巢门部静脉 玻璃样变、脂肪组织 6 女 35 1.5 子宫内静脉 富于细胞、玻璃样变、黏液变性、血栓形成 7 女 41 18 下腔静脉、右心房 黏液变性 8 女 53 1.5 子宫内静脉、腹主动脉旁淋巴结 玻璃样变 9 女 36 6 子宫内 富于细胞、玻璃样变 10 女 49 13 下腔静脉、右髂总静脉、右髂内静脉 黏液变性 11 女 43 18 下腔静脉 玻璃样变及钙化 12 女 46 13 下腔静脉 黏液变性及出血退变、血栓形成 13 女 40 7 宫旁血管 黏液变性 14 女 46 17 宫旁血管 黏液变性 15 女 41 6 子宫肌壁静脉内 部分上皮样改变 16 女 45 4.5 腹壁结节、宫旁腹膜后组织/膀胱左侧壁、盆腔结节 玻璃样变 17 女 43 23 下腔静脉 玻璃样变性及黏液变性 18 女 41 10 下腔静脉、右心房、肺动脉 富于细胞、玻璃样变及黏液变性 19 女 49 6 盆腔血管 玻璃样变 20 女 37 10 下腔静脉、右心房 黏液变性及海绵样变性 
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