细胞外基质和细胞粘附分子在细支气管肺泡癌中的表达与意义

摘要

目的 研究细胞外基质（ECM）中层粘连蛋白（LN）、Ⅳ型胶原（CollⅣ）、纤粘连蛋白（FN）和细胞粘附分子A-CAM在细支气管肺泡癌（BAC）及其三个亚型和肺腺癌（CPA）间的表达特征及意义。方法 采用免疫组化LSAB法，检测50例BAC（包括14例粘液型、22例非粘液型和14例硬化型）和6例CPA中ECM分布和A-CAM表达情况。结果 在LN、CollⅣ、FN分布上，粘液型BAC与癌旁肺实质相同，为在基底膜水平呈完整连续单层窄线性染色；非粘液型BAC则呈连续、不规则增宽的双层轨道样；硬化型BAC外周区域同非粘液型，中央区域与CPA相似，其内癌性腺体基底膜水平处表现为中断或缺如。A-CAM在BAC和CPA中的阳性率分别为60％（30／50）和83％（5／6）（P＞0.05），在BAC三个亚型中则分别为43％（6／14）、55％（12／22）和86％（12／14），呈递增趋势，粘液型显著低于硬化型（P＜0.05），硬化型BAC则与CPA十分接近。结论 从ECM分布和A-CAM的表达来看，BAC整体应视为CPA的一种亚型。粘液型BAC是真正意义上的BAC；BAC三个亚型间及与CPA间可能存在某种分化关系。%Objective To study the expressing features and significance ofextracellular matrix（ECM）-laminin（LN），collagen Ⅳ（Coll IV），fibronectin（FN） and cell adhesion molecule（A-CAM） in the three subtypes of the bronchiolo-alveolar carcinoma（BAC） and conventional pulmonary adenocarcinoma（CPA）. Methods Using immunohistochemical LSAB technique，the distribution and expression of ECM and A-CAM were examined in 50 cases of BAC（including 14 mucinous，22 nonmucinous and 14 sclerosing） and 6 of CPA. Results LN，Coll IV and FN in the basement membrane were stained as uninterrupted narrow line in the mucinous BAC and the pulmonary parenchyma adjacent to the carcinoma. In the nonmucinous BAC，ECM showed as irregular tram-track like double layers. The peripheral areas of the sclerosing BAC was virtually identical in staining pattern to the nonmucinous，and the central areas，which showed disrupted or absent in the basement membrane surrounding the glands embedded in the fibrous stroma，was similar to that of CPA. The frequency of A-CAM expression in BAC and CPA was 60％（30／50） and 83％ （5／6） respectively, with no significant correlation found（P＞0.05）. The percentage of A-CAM in three BAC subtypes was 43％（6／14），55％（12／22） and 86％（12／14），which appeared as increased tendency. There was a significant difference between the mucinous and sclerosing BAC（P＜0.05），while the sclerosing BAC was close to CPA. Conclusion On the basis of the distribution and expression of ECM and A-CAM，BAC should be taken as a subtype of CPA. The mucinous BAC may be a real BAC. Perhaps there is some differentiation correlation among three subtypes of BAC and CPA.