上皮细胞转分化与假性上皮瘤样肉芽肿  

Relationship between epithelial-immunologic cells transdifferentiation and pseudoepitheliomatous granuloma lesion

作　　者：姜笃银 付小兵 陈伟 孙同柱 盛志勇 

机构地区：[1]解放军三四医院全军创伤修复重点实验室,北京100037

出　　处：《中华外科杂志》2004年第7期400-405,共6页Chinese Journal of Surgery

基　　金：国家重大基础研究规划资助项目 (G19990 5 42 0 4) ;国家自然科学基金资助项目 ( 3 0 2 3 0 3 70 )

摘　　要：目的　探讨创伤愈合过程中上皮细胞转分化与假性上皮瘤样肉芽肿 (PEG)发生之间的关系。方法　将 11例来自创 (烧 )伤后继发PEG病变 (n =11)及其边缘正常皮肤 (PEG N ,n =6 )标本 ,采用组织病理学观察PEG上皮组织形态改变 ,并结合免疫组化和间接免疫荧光双标记技术 ,观察抗人广谱角蛋白 (CKp)、CK19、Ⅳ型胶原和层黏连蛋白 (LM )、上皮细胞钙黏附蛋白 (E Cad)、β 连环蛋白 (β Cat)、黏着斑激酶 (FAK)、干细胞因子 (SCF)和受体 (c Kit)、增殖细胞核抗原 (PCNA)、分化抗原簇 14 (CD14 )、CD6 8和肥大细胞类胰蛋白酶 (MCT)在PEG组织中定位和分布特征。结果　与PEG N组相比 ,PEG呈现鳞状上皮化生 ,间质密布微血管结构和炎症细胞 ,可见上皮基底部结构崩溃、细胞顶 基极性丧失或减弱并有较多的细胞向间质迁移 ;超微结构显示上皮基底细胞变形、核 /浆比增加和细胞间隙增宽 ,可见单核 巨噬细胞样细胞和肥大细胞样细胞原位“脱壳”样改变并与基底膜解离。在相同部位免疫标记显示基底细胞CKp、CK19和E Cad被显著下调 ,几乎不表达基底膜Ⅳ型胶原和LM成分 ,但对 β Cat和FAK有较高的免疫反应活性 ,并在上皮组织和间质内发现大小不一的CD14 + 单核细胞、CD6 8+ 巨噬细胞、MCT+ 肥大细胞和CD6 8+ /MCT+Objective Inappropriate treatment at early stage of wound could result in the formation of pseudoepitheliomatous granuloma (PEG). The correlation of abnormal transdifferentiation of epithelial cells to immunologic cells and the occurrence of PEG lesion was investigated. Methods Morphological change of epithelial tissue was observed with histopathology in 11 specimens of PEG lesions and 6 specimens of normal skins from PEG edge (PEG-N) from 11 patients with damaged skin. The expression characteristics and distribution of pan-cytokeratin (CKp), Ⅳ type collagen, laminin (LM), epithelial cadherin (E-Cad), β-catenin (β-Cat), focal adhesion kinase (FAK), stem cell factor (SCF) and its receptor-c-Kit, proliferating cell nuclear antigen(PCNA), and cluster of differentiation-14 (CD14), CD68 and mast cell tryptase (MCT) in PEG were detected with the immunohistochemical and the indirect immunofluorescent double-staining. Results In comparison with PEG-N, epithelial tissue take on squamous metaplasia, and stroma was infiltrated with intensive microvessels and inflammatory cells in the PEG lesion. Poor epithelial basal layer constitution, basal polarization, and migration of basal cells to stroma could be observed. In the ultrastructure, the loose intercellular junction of basal cells and the increased nucleus/cytoplasm ratio and intercellular space could be observed, neonatal monocytoid cells and macrophages and mast cells as a exuviate-like manner brooded from cytoplasm of original epithelial cells and basement membrane. protein expression of CKp and E-Cad by basal cells was significantly decreased, and the Ⅳ type collagen and LM protein could not be found in basement membrane of identical locus. By contrast, the immunoreactivity of β-Cat and FAK was apparently increased. In addition, CD14+ monocytes, CD68+macrophages, MCT+ mast cells and CD68+/MCT+ cells with various size, and these cells of stronger immuno-staining of SCF, c-Kit and PCNA antigen could be found in epithelial tissue and stroma. Conclusion Epithe

关 键 词：上皮细胞转分化 假性上皮瘤样肉芽肿 创伤 免疫组织化学 

分 类 号：R641[医药卫生—外科学]