摘要
目的：为了证实颧部褐青色痣患者真皮浅层内含色素颗粒的细胞是黑素细胞而非噬黑素细胞，从而进一步证实颧部褐青色痣为一种独立的色素痣，并初步了解其黑素细胞的来源；同时探讨颧部褐青色痣患者血清性激素水平及皮损性激素受体与颧部褐青色痣发病的可能机理。为该病的临床诊断、鉴别诊断和治疗提供理论依据。
方法：选取颧部褐青色痣、皮内痣、蓝痣及黑变病标本各10例，均来自昆明医学院第一附属医院皮肤科。所有病理切片标本均进行HE染色、银染色及免疫组化法检测CD68、S-100、Melan-A、NSE、C-Kit(CD117)在黑素细胞上的表达。并针对黑素细胞内合成黑素颗粒的关键酶—酪氨酸羟化酶，设计寡核苷酸探针，经地高辛标记，进行原位杂交实验。用免疫组化法检测雌激素受体(ER)、孕激素受体(PR)及雄激素受体(AR)在颧部褐青色痣及蓝痣石蜡标本上的表达，同时对30例女性NFZ患者采用放射免疫法检测血清性激素(FSH、P、E_2、T、LH及PRL)的水平，并将其结果与健康女性血清性激素水平加以比较。
结果：(1)HE染色：在真皮浅层有散在的梭形含黑素颗粒的细胞分布，细胞长轴与表皮平行，主要分布于真皮浅层。真皮含黑素颗粒细胞分为散在或弥漫的分布。(2)免疫组化及银染色：所有颧部褐青色痣、皮内痣和蓝痣患者中银染色、S-100、Melan-A、NSE、CD68免疫组化均为阳性，其中Melan-A染色在颧部褐青色痣和皮内痣内显示有表皮基底层黑素细胞增加；黑变病组仅有CD68阳性。9例颧部褐青色痣C-kit阳性，8例蓝痣C-kit阳性，5例皮内痣C-kit阳性。5例颧部褐青色痣AR阳性，ER、PR均为阴性；蓝痣内AR、ER及PR均为阴性。(3)原位杂交实验结果：颧部褐青色痣5例阳性，蓝痣6例阳性，皮内痣、黑变病均为阴性。(4)血清性激素检测结果：颧部褐青色痣患者与健康人比较，血清E_3、P、T、FSH、LH、PRL差异无显著性。
结论：颧部褐青色痣表皮基底黑素细胞增加，真皮内既有黑素细胞，也有噬黑素细胞。其黑素细胞是一种痣细胞，有神经嵴来源细胞及早期胚胎细胞的特性，是一种独立的色素痣。颧部褐青色痣的发病与性激素E_2、P、T、FSH、LH、PRL水平无关，但其部分黑素细胞黑素细胞存在雄激素受体。
Object: To explore the presence of dermal melanocytes in naevusfuscoceruleus zygomaticus. Top rove the naevus fuscoceruleus zygomaticusis a special nevus and to know the origin of the dermal melanocytes. Tofind out the correlation among sexual hormones receptor, serum sexualhormone level and the mechanism of naevus fuscoceruleus zygomaticus.
Methods: The samples of 10 cases of naevus fuscoceruleus zygomaticus,10 cases of intradermal nevus, 10 cases of blue nevus, and 10 cases ofmelanosis were all collected from the dermatology department of the firstaffiliated hospital of Kunming Medical College. All the biopsy specimenswere used for histopathology, silver straining and immunohistochemicalanalyses of CD68、S-100、Melan-A、NSE and C-Kit (CD11T) respectively, useda complementary DNA probe for tyrosinase-specific mRNA by in situhybridization (ISH) test. The receptors of sexual hormones on the dermalmelanocytes were also determined by immunohistochemistry staining in skinbiopsy paraffin specimens from naevus fuscoceruleus zygomaticus and bluenevus. The serum sexual hormones (FSH, LH, PRL, E2, T and P) of 30 femalepatients with naevus fuscoceruleus zygomaticus and 30 healthy women wereexamined by radioimmunoassay in the specified period.
Results: (1)HE staining: Under light microscope, dermal melanocytesbipolar or shuttle in shape are found in the upper layer of the dermisin all cases of naevus fuscoceruleus zygomaticus. The long axis of dermal melanocytes is often parallel to the skin surface. Dermal melanocytes areclassified two types, disperse and diffuse. (2) Immunohistochemistry andsilver staining: all cases of naevus fuscoceruleus zygomaticus, intradermal nevus and blue nevus were all positive of S-100, Melan-A, NSE, CD68and silver staining. Melanocytes on the basal layer of epidermis areincrease in Melan-A immunohistochemistry staining on the naevus fuscoceruleus zygomaticus and intradermal nevus. All cases of melanosis wereonly positive of CD68. 9 cases were positive of C-kit on the naevusfuscoceruleus zygomaticus, 8 cases were positive of C-kit on the bluenevus. 5 cases were positive of C-kit on the intradermal nevus. 5 casesof naevus fuscoceruleus zygomaticus were positive of AR, but ER and PRwere all negative. AR, ER and PRwere all negative in 10 cases of blue nevus.(3) In situ hybridization:5 cases of naevus fuscoceruleus zygomaticuswere positive, 6 cases of blue nevus were positive, all cases of intradermalnevus and melanosis were negative. (4) The experimental results of theserum hormones: the levels of serum sexual hormones are normal in allcases. There are no statistical difference in the levels of serum sexualhormones between the naevus fuscoceruleus zygomaticus patients and thecontrol.
Conclusion: The melanocytes in the basal layer of epidermis are increaseon those spicemens in naevus fuscoceruleus zygomaticus patients, thereare melanocytes and melanophage in the dermis, the dermal melanocytes areone of nevus cell and have the some characters nerve crest cell and embryocells. The naevus fuscoceruleus zygomaticus is a kind of independent nevus.Our study show that there may be no relationship between the level of serumsexual hormones and naevus fuscoceruleus zygomaticus, But some dermalmelanocytes in naevus fuscoceruleus zygomaticus have androgenreceptor(AR).
引文
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