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We re-examined 1840 regional lymph nodes which documental no tnmor cells by conventional histopathological examination from 112 female patients with stage I breast cancer using immunohistochemistry LSAB techniques.Monoclonal anticytokeratins(AE1/AE3),anti-EMA,and polyclonal anti-keratins antibodies were used as the primary reagents to identify tumor cells both in tumor tissues and lymph nodes.Over all, immunostaining positive tumor cells were found in 27.7% of lymph nodes of patients(31/112) and 2.27%(50/1840)of... We re-examined 1840 regional lymph nodes which documental no tnmor cells by conventional histopathological examination from 112 female patients with stage I breast cancer using immunohistochemistry LSAB techniques.Monoclonal anticytokeratins(AE1/AE3),anti-EMA,and polyclonal anti-keratins antibodies were used as the primary reagents to identify tumor cells both in tumor tissues and lymph nodes.Over all, immunostaining positive tumor cells were found in 27.7% of lymph nodes of patients(31/112) and 2.27%(50/1840)of the dissected lymph nodes.Seven years postoperative follow-up observation revealed that the incidence of recurrence was high and the latent period of distant metastases was much shorter in patients with occult micrometastases than those without. 112例女性乳腺癌病人手术切除1840枚淋巴结,常规病理检查无癌转移。现用连续切片,单克隆抗细胞角蛋白(AE1/AE3)、抗上皮细胞膜(EMA)抗体及多克隆抗角蛋白抗体对肿瘤组织及所有淋巴结按LSAB法进行免疫染色。几种抗体均对肿瘤组织、淋巴结内微小癌灶及单个癌细胞呈现免疫染色阳性反应,尤以抗EMA抗体反应最强。结果查出27.7%(31/112)病例及2.27%(50/1840)淋巴结内存在隐匿性微小癌转移。其中61例病人经7年随访,显示有隐匿性微小癌转移病人肿瘤复发、远处扩散转移均较无癌转移病人高,而且术后时间短。作者对隐匿性微小癌的淋巴结内转移及其病理生物学与临床意义进行了讨论。 3 715 resected lymph nodes (LN ) contained no metastatic tumor by conventional histopathological examination from 350 patients with different early carcinomas including non - small cell lung carcinoma (NSCLC) 94, breast carcinoma 112, esophageal carcinoma 115, and vulvar carcinoma 29, were re-examined by immunohistochemistry. The results showed:in 56. 4% NSCLC patients (53/94) and 16. 6% LN (123/739) ,27. 7% breast cancer patients (31/112) and 2.72% LN (50/1 840),22. 6% esophsgeal cancer patients (26/115)... 3 715 resected lymph nodes (LN ) contained no metastatic tumor by conventional histopathological examination from 350 patients with different early carcinomas including non - small cell lung carcinoma (NSCLC) 94, breast carcinoma 112, esophageal carcinoma 115, and vulvar carcinoma 29, were re-examined by immunohistochemistry. The results showed:in 56. 4% NSCLC patients (53/94) and 16. 6% LN (123/739) ,27. 7% breast cancer patients (31/112) and 2.72% LN (50/1 840),22. 6% esophsgeal cancer patients (26/115) and 7.0% LN (27/381),and 10. 3% vulvar cancer patients (3/29) and 1.4% LN (3/216), and 32. 3% all cancer patients (113/350) and 5. 5% all examined LN (203/3 715)) micro metastases and/or single cancer cell were found. The incidence of immunostaining positive tumor cells in LN in squamous cell carcinoma (58. 0%),adenocarcinoma (53. 8%) of NSCLC patients was higher than those in esophageal and vulvar squamous cell carcinoma and breast adenocarcinoma (P<0. 005). The frequency in LN was a similar patterns. The data suggested that combined consecutive sections and immunostaining will greatly increase the yield of occult micrometastases in resected LN; the micrometastatic tumor may be the primary step for the further wild dissemination of malignant cells; The rapid metastases and high death rate of lung cancer may be related to,at least partial,the occult metastases;the involved LN were resected as can as possible at surgical therapy as a preventive tumor dissemination will have good outcome. 经常规病理检查切除淋巴结内无癌转移的350例早期癌症病人(肺癌94例、乳腺癌112例、食管癌115例及外阴癌29例)3 715枚淋巴结,用连续切片、免疫组化染色重新检查、单克隆抗细胞膜(EMA)、抗细胞角蛋白(AEI/AE3)、多克隆抗角蛋白抗体免疫染色,查出部分淋巴结内存在微小癌灶或/及单个癌细胞.肺癌病人阴性率为56.4%(53/94 ),淋巴结为16.6%(123/739);乳腺癌病人阳性率为27.7%(31/112),淋巴结为2.72%(50/1840);食管癌病人阳性率为22,6%(26/115),淋巴结为7.0%;处阴癌病人阳性率为10.3%,淋巴结为1.4%.所有癌症病人总阴性率为32.3%,淋巴结为5.5%.肺鳞癌病人阳性率(58.0%)大大高于食管鳞癌(22.5%)与外阴鳞癌(10.3%)(P<0.05);肺腺癌病例阳性率(53%)也明显高于乳腺腺癌(P<0.05).随访材料显示局部淋巴结内存在隐匿性很小癌灶的病例预后较差(P<0.05).研究结果表明:应用连续切片及免疫组化染色可大大提高淋巴结内微小癌灶的检出率.淋巴结内隐匿性微小癌灶可能是恶性肿瘤广泛扩散的第一步.若能在外科手术时尽可能清... 经常规病理检查切除淋巴结内无癌转移的350例早期癌症病人(肺癌94例、乳腺癌112例、食管癌115例及外阴癌29例)3 715枚淋巴结,用连续切片、免疫组化染色重新检查、单克隆抗细胞膜(EMA)、抗细胞角蛋白(AEI/AE3)、多克隆抗角蛋白抗体免疫染色,查出部分淋巴结内存在微小癌灶或/及单个癌细胞.肺癌病人阴性率为56.4%(53/94 ),淋巴结为16.6%(123/739);乳腺癌病人阳性率为27.7%(31/112),淋巴结为2.72%(50/1840);食管癌病人阳性率为22,6%(26/115),淋巴结为7.0%;处阴癌病人阳性率为10.3%,淋巴结为1.4%.所有癌症病人总阴性率为32.3%,淋巴结为5.5%.肺鳞癌病人阳性率(58.0%)大大高于食管鳞癌(22.5%)与外阴鳞癌(10.3%)(P<0.05);肺腺癌病例阳性率(53%)也明显高于乳腺腺癌(P<0.05).随访材料显示局部淋巴结内存在隐匿性很小癌灶的病例预后较差(P<0.05).研究结果表明:应用连续切片及免疫组化染色可大大提高淋巴结内微小癌灶的检出率.淋巴结内隐匿性微小癌灶可能是恶性肿瘤广泛扩散的第一步.若能在外科手术时尽可能清除这类淋巴结,或许可以防止癌广泛转移、播放.从而能更有效地控制恶性肿瘤以提高治愈率. Objective:Bax gene is an important apoptosispromoting gene. ln order to investigate the expression of Bax in oral premalignant lesions and oral squamous cell carcinomas, a total of 38 samples are evaluated using a labelled streptavidin biotin (LSAB) immunohistochemical assay. Methods: A total of 38 specimens were studied, including normal oral mucosa, premalignant lesions and squamous cell carcinomas. The specimens were obtained and blocked, fixed with 10% buffered formalin and embedded in paraffin using conventional... Objective:Bax gene is an important apoptosispromoting gene. ln order to investigate the expression of Bax in oral premalignant lesions and oral squamous cell carcinomas, a total of 38 samples are evaluated using a labelled streptavidin biotin (LSAB) immunohistochemical assay. Methods: A total of 38 specimens were studied, including normal oral mucosa, premalignant lesions and squamous cell carcinomas. The specimens were obtained and blocked, fixed with 10% buffered formalin and embedded in paraffin using conventional histopathological techniques. 3 μm thick sections of paraffin embedded tissues were cut, mounted onto slides coated with 5% APES (3 aminopropyltriethoxysilane), dried overnight at 56℃, dewaxed in xylene and rehydrated through descending graded alcohols to phosphate buffered saline (PBS, pH 7.4). For antigen retrieval, slides were immersed in 10 mmol/L sodium citrate buffer (pH 6 0) and boiled twice for 5min in a microwave oven (800 W). After treated for 10 min with 3% H\-2O\-2, 18% methanol in PBS, the slides were covered with 10% normal porcine serum for 10 min at 37℃. Then slides were incubated with primary antibody (bax rabbit polyclonal antibody) for 60 min at 37℃ and were subsequently incubated with prediluted biotinylated antibody against rabbit immunogobulins, and streptavidinhorseradish peroxidase conjugate for 30 min at 37℃. After washing, peroxidase activity was detected using 3,3' diaminobenzidine as chromogen with H\-2O\-2 as substrate. The cells in the test specimens which demonstrated granular staining were considered as positive. A haemocytometer counter with 6\+*6 framework were applied and only the positive cells on the cross were counted. The cell counting were processed in ten randomly chosen 400\+* microscopic fields and the mathematic mean was presented as the final counting of each sample. Statistical valuations were performed using the version 6.0 SPSS package. Positive controls were sections of bladder cancer tissues. Blank controls were fabricated for each specimen by the omission of the primary antibody, which was replaced with PBS.\ Results: In the process of oral carcinogenesis, each stage had Bax expression. The positive staining appeared in cytoplasm.\ In the normal oral mucosal specimens Bax expression was evident in the prickle layer, but not in the basal cell layers. Various degrees of Bax expression were seen in the diseased tissues. The staining pattern of hyperkeratotic lesions was similar to the normal oral mucosa, but Bax expression were also seen in the basal cell layer.\ In the mild, moderate, severe dysplasia and squamous cell carcinomas, Bax expression were seen in all layers, however, the intensity of staining were greater in mild and moderate dysplasia. The number of positive cells tended to increase gradually with the development of cell maligancy in the tissues of hyperkeratosis, mild and moderate dysplasia (P<0 05). In the tissue of squamous cell carcinomas the number of positive cells had no marked difference comparing with the normal oral mucosa. Conclusion: The expression of Bax is involved in oral carcinogenesis and the compensative increase of Bax protein expression may be an early response. 目的 :初步探讨Bax基因蛋白产物Bax蛋白在口腔粘膜癌前损害发生发展过程中的作用及变化的规律。方法 :分别选出正常口腔粘膜、上皮单纯增生、上皮轻度异常增生、上皮中度异常增生、上皮重度异常增生、鳞状细胞癌标本共 38例 ,采用免疫组织化学染色技术———酶标链亲和素生物素法 (LSAB)染色并进行光镜下观察。结果 :光镜下可见 ,各阶段均有Bax蛋白表达 ,为细胞浆阳性 ,从正常口腔粘膜组织、上皮单纯增生到中度上皮异常增生 ,其阳性反应数量和强度呈递增趋势 (P <0 0 5 ) ,至鳞癌阶段 ,Bax蛋白的阳性反应数量和强度与正常组比较无明显差异 (P >0 0 5 )。结论 :Bax蛋白表达水平代偿性增高是人类口腔粘膜癌前损害发生发展过程中的早期表现。
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