目的探讨细胞外基质在乳腺癌浸润转移中的作用及意义。方法应用病理形态观察及免疫组织化学技术对50例乳腺癌及23例淋巴结转移灶的层粘蛋白、Ⅳ型胶原蛋白表达进行检测。结果在浸润性乳腺癌中，层粘蛋白和Ⅳ型胶原失去在正常乳腺组织及乳腺良性病变组织中的连续线状表达，表现为间断线状、条索状、碎片状或缺如。层粘蛋白和Ⅳ型胶原的表达与乳腺癌组织学分级、淋巴结转移及病理核分裂间具有显著相关性(P<0.05)，而与组织学分型、肿瘤大小及瘤栓之间未见相关性。在淋巴结转移灶中，除脉管对Ⅳ型胶原及层粘蛋白呈阳性表达外，也见个别转移癌细胞胞浆对层粘蛋白呈阳性反应，部分转移灶癌细胞间存在着碎片状层粘蛋白表达，癌细胞巢周围没有连续的或间短的线状表达。结论随着乳腺癌进展,细胞外基质表达逐渐下调，并与组织学分级、淋巴结转移及病理核分裂密切相关，表明分化越差，病理核分裂像越多，转移能力越强的肿瘤破坏基底膜的能力越强。癌细胞具有产生基底膜样物质的能力，可能与肿瘤细胞的浸润活性有关。%Objective To explore the possible role and mechanism of extracellular matrix in the invasion and metastasis of breast cancer.Methods The expression of laminin and collagenⅣ in 50 cases of breast carcinoma and 23 axillary lymph nodes with metastasis was immunohistochemically detected.Results By Immunohistochemical staining, the tissues of breast carcinoma showed negative reaction for collagenⅣ and laminin or positive reaction in interrupted linear pattern or fragmentary pattern, without continuous linear pattern as shown in normal tissues and benign lesions of the breast. The expressions of collagen Ⅳ and laminin were correlated with the histological grading(P<0.01), metastasis (P<0.01) and pathologic mitosis(P<0.05) of breast carcinoma, but no correlation was found between the expressions and the histological type, tumor size and intravascular cancer cell emboli. In the metastatic focus, the positive staining for laminin was observed in tumor cell cytoplasm and extracellular matrix in fragmentary pattern.Conclusion Extracellular matrix is reducted with the tumor progression,and significantly correlated with the differentiation,metastasis and pathologic mitosis of breast carcinomas, indicating that poorly differentiated tumors with more mitosis and great potential to metastasize has stronger ability to destroy basement membranes. Some cancer cells are able to synthesize components of basement membrane, which may be responsible for the invasive activity of tumor cells.
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