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간세포암종에서 조직내 HBsAg과 HBcAg의 발현에 대한 면역조직화학적 연구

Title
 간세포암종에서 조직내 HBsAg과 HBcAg의 발현에 대한 면역조직화학적 연구 
Other Titles
 (An) immunohistochemical study on the expression of HBsAg and HBcAg in patients with hepatocellular carcinoma 
Issue Date
1991
Publisher
 연세대학교 대학원 
Description
의학과/석사
Abstract
[한글] 간세포암종에서 HBsAg과 HBcAg의 조직 내 발현에 관한 연구는 많은 저자들에 의해 이루어져 왔으나 이들의 발현 빈도는 보고자마다 큰 차이가 있고. 그 발현 양상에 대한 구체적인 언급은 없다. 저자는 1985년부터 1991년까지 연세의료원 산하기관과 원주기독병원에 서 간세포암종으로 진단되어 외과적 절제를 받은 47예를 대상으로 간암조직과 주변조직에서 HBsAg과 HBcAg에 대한 면역조직화학적 검색을 시행하여 혈청 HBsAg과 HBeAg상태, 수술 전 치료여부, 간암의 옥안 형태, 간암세포의 분화정도, 주변조직의 간경변증 및 이형성 유무에 따른 HBsAg과 HBcAg의 발현빈도와 발현양상을 비교하여 다음과 같은 결과를 얻었다. 1. 간암조직에서 HBsAg은 20예(42.6%)에서 발현되었고, HBcAg의 발현은 한 예도 없었으며, 주변조직에서 HBsAg은 38예(80.9%),HBcAg은 11예(23.4%)에서 발현되었다. 혈청 HBsAg이 양성인 40예 중 간암조직에서 HBsAg은 20예(50%)에서 발현되었고 주변조직에서는 HBsA g은 38예(90.5%), HBcAg은 11예(27.5%)에서 발현되었다. 혈청 HBsAg이 음성인 7예 중 조직 내 HBsAg과 HBcAg이 발현된 예는 없었다. 2. 혈청 HBeAg이 양성인 경우 주변조직의 HBcAg이 발현된 경우가 4예(57.1%)로 HBeAg이 음성인 경우보다 많았다. 3. 수술 전 치료를 받은 군에서 받지 않은 군에 비해 간암조직 및 주변조직에서 HBsAg과 HBcAg의 발현빈도가 높았다. 4. 간암의 옥안적 유형 중 유사경변형인 경우 간암조직 내 HBsAg과 주변조직의 HBcAg의 발현이 각각 3예씩(60%)으로서 다른 유형보다 높았다. 5. Edmondson-Stainer분류에 따른 간세포암종의 분화도 등급 Ⅳ인 간세포암종때 간암조직 내에서 HBeAg의 발현 예가 17(25%)로 분화가 좋은 경우보다 낮았다. 6. 간암조직 및 주변조직에서 HBsAg의 발현빈도는 간경변증 동반 유무와는 유의한 차이가 없었고 주변조직에 이형성이 있는 경우에는 이형성이 없는 경우보다 높았다. 7. 조직 내 HBsAg과 HBcAg의 발현양상은 모두 집단으로 분포하는 군이 산재해서 분포하는 군보다 많았으며, 세포 내 발현양상은 HBsAg은 세포질 내에 골고루 분포하는 양상이 많았지만, 활동성 간경변증인 경우에는 비활동성 간경변증 보다 세포막을 따라 양성인 경우가 상대적으로 많았고,(41.7% vs 5.7%) HBcAg은 세포질과 핵에 동시에 양성인 경우가 많았다. 이상의 결과로서 간암세포 내에서는 HBV-DNA가 핵에 모두 삽입되어 HBcAg의 발현이 되지 않으며, 조직학적 분화도가 나쁜 간세포암종에서는 HBsAg의 mRNA형성이 낮아지는 것으로 사료된다. 간경변증이 동반된 경우, 주변조직의 결절에서 HBV표지자가 집단으로 분포하며 간암조직에서 또한 집단으로 분포하는 것으로 보아 간세포암종은 단세포성 증식일 것으로 추측된다. An immunohistochemical study on the expression of HBsAg and HBcAg in patients with hepatocellular carcinoma Jee Young Han Department of medical science, The graduate School, Yonsei University (Directed by Professor Chan Ⅱ Park) The expression rate and distribution pattern of HBsAg and HBcAg were studied in 47 patients with hepatocellular carcinoma(HCC) according to the status of serum HBsAg and HBeAg, preoperativetreatment, gross pattern of the hepatocellular carcinoma, histologic grade of HCC and presence or absence of liver cirrhosis or dysplasia in the remaining liver. The HBsAg was detected in the cytoplasm of non-carcinomatous hepatocytes in 38 (80.9%) cases and of carcinoma cells in 20 (42.6%) cases, HBcAg was stained in the remainig liver in 11 (23.4%) cases and none in carcinoma cells. HBeAg-seropositive cases showed higher positive rate of HBcAg expression in the remaining liver than that of HBeAg-seronegative cases. The positive rate of expression for HBsAg and HBcAg in the HCC and remaining liver was higher in the cases on which preoperative treatment was done. Grossly cirrhotomimetic type of HCC showed highest positive rates of expression for HBsAg and HBcAg in the HCC and the remaining liver. In the histologic grade of tumor, the rate of expression for HBsAg was lowest in the grade Ⅳ. Rate of expression far HBsAg was higher in the cases with dysplasia of hepatocytes in the remaining liver. The patterns of distribution of HBsAg and HBcAg were divided into two groups ; grouped pattern vs scattered pattern. The distribution of HBsAg and HBcAg showed predominantly grouped pattern in HCC and remaining non-carcinomatous tissue. The HBcAg was detected both in the cytoplasms and nuclei in most cases(81.8%) and HBsAg was only stained in the cytoplasms by diffuse pattern (71.1% in the remaining liver and 90.0% in the HCC) but proportion of membraneous pattern is higher in the active liver cirrhosis (41.7%) compared to inactive liver cirrhosis (5.7%). In conclusion, it is suggested that because the H8V-DNA was already intergrated into the nuclei of the HCC, the HBcAg is not found in the tumor and the reason that rate of expression for HBsAg is reduced in the grade Ⅳ HCC was due to decreased replication of mRNA of HBsAg. The distribution of HBsAg and HBcAg showed grouped pattern both in HCC and in the remaining liver, which might indicate the possibility of monoclonal origin of HCC cells.
[영문] The expression rate and distribution pattern of HBsAg and HBcAg were studied in 47 patients with hepatocellular carcinoma(HCC) according to the status of serum HBsAg and HBeAg, preoperativetreatment, gross pattern of the hepatocellular carcinoma, histologic grade of HCC and presence or absence of liver cirrhosis or dysplasia in the remaining liver. The HBsAg was detected in the cytoplasm of non-carcinomatous hepatocytes in 38 (80.9%) cases and of carcinoma cells in 20 (42.6%) cases, HBcAg was stained in the remainig liver in 11 (23.4%) cases and none in carcinoma cells. HBeAg-seropositive cases showed higher positive rate of HBcAg expression in the remaining liver than that of HBeAg-seronegative cases. The positive rate of expression for HBsAg and HBcAg in the HCC and remaining liver was higher in the cases on which preoperative treatment was done. Grossly cirrhotomimetic type of HCC showed highest positive rates of expression for HBsAg and HBcAg in the HCC and the remaining liver. In the histologic grade of tumor, the rate of expression for HBsAg was lowest in the grade Ⅳ. Rate of expression far HBsAg was higher in the cases with dysplasia of hepatocytes in the remaining liver. The patterns of distribution of HBsAg and HBcAg were divided into two groups ; grouped pattern vs scattered pattern. The distribution of HBsAg and HBcAg showed predominantly grouped pattern in HCC and remaining non-carcinomatous tissue. The HBcAg was detected both in the cytoplasms and nuclei in most cases(81.8%) and HBsAg was only stained in the cytoplasms by diffuse pattern (71.1% in the remaining liver and 90.0% in the HCC) but proportion of membraneous pattern is higher in the active liver cirrhosis (41.7%) compared to inactive liver cirrhosis (5.7%). In conclusion, it is suggested that because the H8V-DNA was already intergrated into the nuclei of the HCC, the HBcAg is not found in the tumor and the reason that rate of expression for HBsAg is reduced in the grade Ⅳ HCC was due to decreased replication of mRNA of HBsAg. The distribution of HBsAg and HBcAg showed grouped pattern both in HCC and in the remaining liver, which might indicate the possibility of monoclonal origin of HCC cells.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/117336
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2. 학위논문 > 1. College of Medicine (의과대학) > 석사
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