Survivin Protein Expression In The Tissue Of Extramammary Paget's Disease And Its Correlation With P53 Protein Expression

Objective To explore the clinical significance of expression of inhibiting apoptosis gene survivin in the tissue of Extramammary Paget's disease (EMPD) and its correlation with p53 protein expression. So as to provide objective evidence for clinical diagnose and therapy of EMPD. Crocker, in 1889, described the first patient with extramammary Paget's disease . Extramammary Paget's disease (EMPD) is a rare malignant intraepithelial neoplasm of genital region , perineum or apocrine gland bearing skin in aged people. and is frequently associated with underlying sweat gland or visceral malignancy. It's characterized by eczematous lesions in clinical and Paget's cells in histological. The histogenesis of EMPD has long been a subject of controversy. The tumour cells can invade the dermis and may metastasize via the lymphatic system. Survivin is a kind of inhibitory of apoptosis protein with unique structure, which is a highly conservative expression product of inhibitory of apoptosis gene and can protect cell from inducing by a series of stimulating factors to apoptosis. Studies show that survivin could be expressed in embryo but not in adult end differentiated tissue. In tumor tissues there is an abundant expression of survivin, which present a new target for diagnosis and treatment.Methods S-P immunohistochemistry technology was used to detect the expression of survivin and p53 protein in 32 cases of EMPD, 10 cases of seborrheic keratosis ,20 cases of chronic eczema in anogenital region and 20 cases of normal skin tissues from skin surgery department. Laboratory data were the analyzed statistically together with the related clinical-pathological data.Results The positive expression rate of survivin in 32 cases of EMPD was 68.8% (22/32),which was significantly higher than that in seborrheic keratosis, which positive expression rate is 20%(2/10), the difference was statistically significant(P< 0.05), we could not observe surviving expression in chronic eczema and normal skin tissues. The expression of Survivin was not significantly correlated with age, gender, dermis infiltration, lymph node metastasis and recurrence in EMPD(P>0.05). The positive expression rate of p53 was 56.3% (18/32), which was significantly higher than that in seborrheic keratosis, which positive expression rate is 10%(1/10), the difference was statistically significant(P<0.05), we could not observe p53 expression in chronic eczema and normal skin tissues. The expression of p53 was not significantly correlated with age, gender, dermis infiltration, lymph node metastasis and recurrence in EMPD(P>0.05). The positive expression rate of survivin in patients with positive and negative p53 expression were 88.9% (16/18) and 42.9% (6/14) respectively. The difference was statistically significant(P<0.05).Conclusion The apoptosis inhibition, resulted from high expression of survivin, may play an important role in the carcinogenesis and development of EMPD. The expression of survivin have specific selectivity in tissue distribution. survivin may be identified as a defining diagnostic marker and a potential gene therapeutic target in EMPD. The expression of Survivin was not significantly correlated with age, gender, dermis infiltration, lymph node metastasis and recurrence in EMPD , indicating that the up-regulation expression of suvivin is just relate to nosogenesis of EMPD. It's just a biological parameter reflecting growth of EMPD. The high expression of p53 in EMPD and the expression of p53 was not significantly correlated with age, gender, dermis infiltration, lymph node metastasis and recurrence in EMPD ,indicating that mutant p53 is closely relate to EMPD. The expression of survivin in EMPD closely relates to that of p53 gene, indicating that they may play a cooperative role in this process and contribute to multiple ways to inhibit apoptosis of Paget cells. P53 mutate may be one of the reasons for the abnomal expression of suvivin.