난소상피종양의조직학적 양상과 증식세포핵항원의 발현 및 유세포측정 소견과의 관계

Abstract

[한글]

난소의 상피종양 중 악성 종양과 경계성 종양은 예후가 크게 차이 나기 때문에 정확한 진단과 예후 예측이 환자의 치료방침을 정하는데 매우 중요하다. 그러나 명확한 진단기준이 있음에도 불구하고 기질내 침윤이 명백하게 확인되지 않는 경우 경계성 종양과 악성 종양을 구분하는 것이 어렵고 주관적인 판독에 의존해야하기 때문에 개인간에 진단의 차이가 발생할 수 있어 종양의 정확한 악성 등급을 정하는데 좀 더 객관적인 방법이 요구되어 종양에서 증식하는 세포가 차지하는 부분을 정량화 하는 방법이 객관적인 예후 측정 방법의 하나로 대두되고 있다. 본 연구는 1981년 1월부터 1992년 7월까지 연세대학교 원주의과대학 원주기독병원과 연세대학교 의과대학 세브란스병원에서 난소의 장액성 또는 점액성 종양으로 진단받은 예 중 84예를 대상으로, 유세포 측정기를 이용한 DNA 분석에서 얻어진 합성기 분획 및 증식 지수와 합성기 연관항원인 중식세포핵항원(proliferating c

ell nuclear antigen 이하 PCNA)에 대한 면역조직화학염색을 통해 정량화한 발현지수를 서로 비교하고, 조직학적 소견과 비교하여 진단 및 예후 예측과의 관계를 조사하여 다음과 같은 결과를 얻었다.

1. 악성 종양은 양성 종양과 비교시 비배수성이 많았으나, 경계성 종양에서 이배수성과 비배수성의 수는 큰 차이가 없었다.

2. PCNA 발현지수, 합성기 분획 및 증식 지수는 악성도가 높을수록 증가하는 경향을 보였으며, 악성 종양애서 양성 및 경계성 종양보다 높았다.

3. PCNA 발현지수, 합성기 분획 및 증식 지수는 이배수성 보다 비배수성에서 더 높았다.

4. 악성 종양에서 PCNA 발현지수는 경계성 종양에 비해 특히 유사분열 지수와 의의있는 상관관계를 보였으며, 합성기 분획 및 증식지수는 특히 구조적 등급 및 핵소체 등급과 의의있는 상관관계를 보였다.

이상과 같은 결과를 종합해 보면 난소상피종양얘서 비배수성 여부, PCNA 발현지수, 합성기 분획 및 증시지수는 악성 여부가 불확실 한 경우의 감별진단에 유용한 자료가 될 것으로 생각된다.

Correlation of histologic findings of ovarian epithelial tumors with expression of

proliferating cell nuclear antigen and flow cytometric analysis

Sang Yeop Yl Department of Medical Science The Graduate School,

Yonsei University

(Directed by Professor Kwang Gil Lee)

The prognosis of a malignant ovarian tumor is poorer than that of a borderline

malignant ovarian tumor. Thereafter an accurate diagnosis and estimation of the

biologic behavior of the tumor are necessary for proper management of the patient.

The histologic investigation of the tumor may provide information on the estimation

of the malignant potential of tumor cells, but it may be a questionable method

because of the subjective determination of tumor grade. Quantification of

proliferative activity of tumor cells may play a role as an objective method to

provide an estimation of the malignant potential of tumor cells. An evaluation of

histologic findings was done on 84 cases of ovarian mucinous and serous tumors

which were surgically resected and diagnosed in the period from January 1981

through July 1992. The S-phase fraction and proliferative index obtained from flow

cytometric DNA analysis and the proliferating cell nuclear :antigen(PCNA) labelling

index estimated from the immunohistochemical stain for PCNA are assessed with each

other with histologic findings. The result are as follows.

1. The presence of aneuploidy in malignant tumors was significant as compared

with benign tumors. The borderline malignant tumor showed no significant difference

between the number of diploidy and aneuploidy.

2. The PCNA labelling index, S-phase fraction and proliferative index tended to

increase as the histologic grade of tumors went up. They were higher in malignant

tumors than in others.

3. The PCNA labelling index, S-phase fraction and proliferative index were higher

in tumors with aneuploidy than in those with diploidy.

4. In contrast to low-grade malignant lesions, the PCNA labelling index in

malgnant tumors revealed a significant relation with the mitotic index. The S-phase

fraction and proliferative index showed, in malignat tumors, a close correlation

with the architectural grade and nucleolar grade, but not in low grade malignant

tumors.

Based on these results, the presence of aneuploidy. PCNA labelling index, S-phase

fraction, and proliferative index are considered to be valuable data in making a

decision on equivocal cases of ovarian epithelial tumors.

[영문]

The prognosis of a malignant ovarian tumor is poorer than that of a borderline malignant ovarian tumor. Thereafter an accurate diagnosis and estimation of the biologic behavior of the tumor are necessary for proper management of the patient.

The histologic investigation of the tumor may provide information on the estimation of the malignant potential of tumor cells, but it may be a questionable method because of the subjective determination of tumor grade. Quantification of proliferative activity of tumor cells may play a role as an objective method to

provide an estimation of the malignant potential of tumor cells. An evaluation of histologic findings was done on 84 cases of ovarian mucinous and serous tumors which were surgically resected and diagnosed in the period from January 1981 through July 1992. The S-phase fraction and proliferative index obtained from flow

cytometric DNA analysis and the proliferating cell nuclear :antigen(PCNA) labelling index estimated from the immunohistochemical stain for PCNA are assessed with each

other with histologic findings. The result are as follows.

1. The presence of aneuploidy in malignant tumors was significant as compared with benign tumors. The borderline malignant tumor showed no significant difference between the number of diploidy and aneuploidy.

2. The PCNA labelling index, S-phase fraction and proliferative index tended to increase as the histologic grade of tumors went up. They were higher in malignant tumors than in others.

3. The PCNA labelling index, S-phase fraction and proliferative index were higher in tumors with aneuploidy than in those with diploidy.

4. In contrast to low-grade malignant lesions, the PCNA labelling index in malgnant tumors revealed a significant relation with the mitotic index. The S-phase fraction and proliferative index showed, in malignat tumors, a close correlation with the architectural grade and nucleolar grade, but not in low grade malignant tumors.

Based on these results, the presence of aneuploidy. PCNA labelling index, S-phase fraction, and proliferative index are considered to be valuable data in making a decision on equivocal cases of ovarian epithelial tumors.