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BRAF Mutation Is Associated With a Specific Cell Type With Features Suggestive of Senescence in Ovarian Serous Borderline (Atypical Proliferative) Tumors.

BRAF突变与卵巢浆液性交界性肿瘤中的一种特殊类型细胞有关,这类细胞具有提示衰老的特征。

Zeppernick F,Ardighieri L,Hannibal CG,Vang R,Junge J,Kjaer SK,Zhang R,Kurman RJ,Shih IeM

Abstract

Serous borderline tumor also known as atypical proliferative serous tumor (APST) is the precursor of ovarian low-grade serous carcinoma (LGSC). In this study, we correlated the morphologic and immunohistochemical phenotypes of 71 APSTs and 18 LGSCs with the mutational status of KRAS and BRAF, the most common molecular genetic changes in these neoplasms. A subset of cells characterized by abundant eosinophilic cytoplasm (EC), discrete cell borders, and bland nuclei was identified in all (100%) 25 BRAF-mutated APSTs but in only 5 (10%) of 46 APSTs without BRAF mutations (P<0.0001). Among the 18 LGSCs, EC cells were found in only 2, and both contained BRAF mutations. The EC cells were present admixed with cuboidal and columnar cells lining the papillae and appeared to be budding from the surface, resulting in individual cells and clusters of detached cells "floating" above the papillae. Immunohistochemistry showed that the EC cells always expressed p16, a senescence-associated marker, and had a significantly lower Ki-67 labeling index than adjacent cuboidal and columnar cells (P=0.02). In vitro studies supported the interpretation that these cells were undergoing senescence, as the same morphologic features could be reproduced in cultured epithelial cells by ectopic expression of BRAF. Senescence was further established by markers such as SA-β-gal staining, expression of p16 and p21, and reduction in DNA synthesis. In conclusion, this study sheds light on the pathogenesis of this unique group of ovarian tumors by showing that BRAF mutation is associated with cellular senescence and the presence of a specific cell type characterized by abundant EC. This "oncogene-induced senescence" phenotype may represent a mechanism that impedes progression of APSTs to LGSC.

摘要

浆液性交界性肿瘤又称非典型增生性浆液性肿瘤 (APST) 是卵巢低级别浆液性癌 (LGSC)的前驱病变。本研究,我们将71例APST和18例LGSC的形态和免疫表型与KRAS和BRAF的突变(这些肿瘤中最常见的分子遗传学变化)状态联系起来。在25例 (100%)具有BRAF突变的浆液性交界性肿瘤中,均为大量嗜酸性胞质、细胞界限不清、核淡染的细胞亚群,而在46例无BRAF突变的浆液性肿瘤中只有5例(10%)具有该细胞亚群 (P<0.0001)。在18例低级别浆液性癌中,只有2例发现有嗜酸性细胞,而且这两例都具有BRAF突变。这些嗜酸性细胞与立方状和柱状上皮混杂,衬附于乳头表面,而且似乎是从表面出芽生长,产生细胞和一些游离细胞簇漂浮在乳头上方,免疫组化显示嗜酸性细胞总是表达P16,这是一种衰老相关性标记,而且Ki67的指数明显低于邻近的立方和柱状细胞( (P=0.02)。体外实验研究认为这些细胞正在逐渐老化,因为同样的形态特征可以通过BRAF异位表达于人工培养的上皮细胞中而重现。SA-β-gal 染色、P16表达、P21表达以及DNA合成的减少进一步证实了老化。总之,本研究通过证实BRAF突变与细胞老化、以及具有丰富嗜酸性胞浆这一特殊类型细胞的出现有关,阐明了该类特殊卵巢肿瘤的发病机理。这种致癌基因诱导的老化现象可能正是阻止交界性浆液性肿瘤进展为低级别浆液性癌的机制。

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