摘要目的 探讨p16、GATA3的表达及人乳头状瘤病毒(HPV)分型检测在宫颈癌累犯膀胱病理诊断中的价值.方法 收集2008年12月至2016年3月16例宫颈癌累犯膀胱标本,对其进行组织学观察,采用免疫组织化学检测p16、GATA3的表达水平,采用PCR-反向点杂交法检测HPV基因分型.结果 患者发病年龄25~76岁,中位年龄52岁.宫颈癌累犯膀胱病例中,14例(14/16)肿瘤细胞在膀胱固有层或肌层内巢状浸润.免疫组织化学示15例(15/16)膀胱病灶弥漫强表达p16,1例10%细胞表达;7例(7/7)宫颈原发灶均弥漫强阳性.13例(13/16)膀胱病灶GATA3染色阴性,3例局部弱-中等阳性(≤30%);3例(3/7)宫颈原发灶弱-中等阳性(≤20%).15例(15/16)高危型HPV阳性,其中8例HPV16型,1例HPV31型,5例为HPV16+HPV18双重基因型,1例HPV18+HPV45双重基因型. 结论 单独使用p16或GATA3鉴别诊断价值有限.结合病史p16、GATA3免疫组织化学和HPV分型检测可有助于宫颈癌累犯膀胱病例的诊断与鉴别诊断.

abstractsObjective To investigate the expression of p16 and GATA3 and the detection of human papillomavirus (HPV) in secondary bladder involvement by cervical carcinomas.Methods Sixteen cases of cervical carcinoma with bladder involvement diagnosed from December 2008 to March 2016 were collected and evaluated by light microscopy, immunohistochemistry for p16 and GATA3 detection and PCR-reverse dot blot for molecular typing of HPV.Results The age of the patients ranged from 25 to 76 years with median of 52 years.Morphologically, 14 cases(14/16) showed tumor nests infiltrating lamina propria or muscle bundles of the bladder.By immunohistochemistry, 15 cases (15/16) were found to be diffusely and strongly positive for p16, and 1 showed patchy staining pattern.Seven cases (7/7) of corresponding original cervical cancers were also diffusely and strongly positive for p16.GATA3 staining was negative in 13 cases (13/16), and focal weak to moderate positivity was detected in 3 cases.Three cases (3/7) of corresponding original cervical cancers showed focal weak to moderate positivity of GATA3.Fifteen cases (15/16) showed concordant high risk HPV-positivity, including HPV16 in 8 cases and HPV31 in one case.Five cases showed co-infection of HPV16 and HPV18.One case showed co-infection with HPV18 and HPV45.Conclusion Differential diagnosis by p16 or GATA3 alone is of limited value.Combination of immunohistochemistry for p16 and GATA3 and molecular typing for HPV detection are useful to distinguish primary bladder carcinoma from the secondary involvement by cervical carcinoma.