- 期刊
Evaluation of Proliferative Activity in Middle Ear Cholesteatoma Using Proliferating Cell Nuclear Antigen
利用增殖細胞核抗原評估中耳膽脂瘤的增殖活性
摘要
膽脂瘤（cholesteatoma）組織在病理上，是很類似皮膚的構造；在臨床上卻具有相當的侵蝕性。在中耳腔中，若未經過完全的手術切除，會對聽小骨及乳突骨產生嚴重的破壞。增殖細胞核抗原（proliferating cell nuclear antigen, PCNA）是一種在細胞生殖週期中的G1後期和S期合成的一種核蛋白，其出現陽性細胞的多寡與細胞的增值活性有密切的正相關。本研究利用免疫組織化學酵素抗體法（avidin-biotin-per-oxidase complex; ABC method）以PCNA單株抗體免疫染色，在顯微鏡下觀察比較中耳膽脂瘤和耳廓後皮膚兩者組織上皮內PCNA陽性細胞之分佈表現。在37例（平均年齡37歲）中耳膽脂瘤上皮組織中，PCNA陽性百分比在basal layer, parabasal layer及upper layer分別為78％（29例），68％（25例），及41％（15例），而在21例（平均年齡39歲）耳廓後皮膚上皮組織中，其百分比依序分別為71％（15例），67％（14例）及34％（7例），雖然在膽脂瘤上皮組織中，PCNA陽性細胞出現機率較高，但利用卡方檢定兩者之PCNA陽性細胞出現的百分比，並無統計學上的差異。免疫組織化酵素抗體法具有可保持細胞組織架構、方法簡單、可快速得到結果等優點。以單株抗體免疫染色，應用於石臘包埋、福馬林固定的組織標本，對臨床上測定細胞增值活性是一有效標記。本研究得知中耳膽脂瘤上皮組織中，其細胞增值活性與耳廓後正常皮膚相比較雖然有增加，但不具統計學上的差異，顯示中耳膽脂瘤並不是一個真正的腫瘤增生組織。利用此PCNA標記提供的細胞增值活性動力學，是否對於我們在處理膽脂瘤的方式及預後可以提供一有用的臨床訊息，仍需要進一步的研究。
關鍵字
無資料並列摘要
Middle ear cholesteatoma has a remarkable invasive activity accompanied by destruction of ossicles and temporal bone. Its aggressive growth and high tendency to recur have impact on the postoperative care of the patients. Proliferating cell nuclear antigen (PCNA) is a 36 KDa DNA-delta-polymerase-associated protein whose level of synthesis has been found to correlate directly with rates of cellular proliferation. In this present study, we used ABC (avidin-biotin complex) technique and monoclonal antibody to PCNA to evaluate the expression of PCNA in 37 cases of cholesteatoma epithelium and 21 cases of normal postauricular skin. The rate of PCNA- positive cells in basal, parabasal, and upper layer of cholesteatoma epithelium tissue is 78% (29 cases), 68% (25 cases), and 41% (15 cases). In each layer of the postauricular skin tissue is 71% (15 cases), 67% (14 cases) and 34% (7 cases). No statistical difference of expression of PCNA-positive cells exists between each layer of cholesteatoma epithelium and normal postauricular skin; however, a tendency of higher PCNA-positive cells in cholesteatoma epithelium was observed. Immunohistochemical method of PCNA has the advantages of spatial architecture preservation, the relative simplicity of the methodology and the rapid acquisition of results. Although the etiology and histopathology of the growth pattern and osteolytic activity of cholesteatoma are unclear, information on cell kinetics may assist in cholesteatoma classification and may help predict the risk of recurrence and bone destruction. The results of this report indicate that cholesteatoma has a similar proliferative activity to the normal postauricular skin, and cholesteatoma itself is not a real tumor, despite its clinical behavior, which is similar to neoplastic cells. It is necessary to further study whether the cell kinetic information we obtained from the PCNA immunohistochemical analysis provides a valuable tool in accessing the prognosis of the cholesteatoma.
延伸閱讀
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