手部腱鞘巨细胞瘤的临床病理研究与免疫组化及流式细胞分析

Giant cell tumor of tendon sheath in the hand:a clinicopathological,immunohistochemical and flow cytometric DNA analysis

目的总结腱鞘巨细胞瘤的特点,探索与其术后复发相关的临床病理因素,及其内在生物学特性与复发的关系。方法共收集有长期随访结果的手部腱鞘巨细胞瘤83例,对患者的临床病理资料进行复习,探索各临床病理因素与复发的关系;并对其进行免疫组化及流式细胞分析。结果随访8个月～23年,平均55个月,83例中22例(26.5%)复发。肿物复发与患者年龄、性别、肿物部位、大小、骨骼改变、肿物来源(关节内或关节外)等临床因素及肿物细胞含量、核分裂相多少等病理因素无关。而无明显包膜的肿物复发率显著高于包膜完整的肿物。Nm23蛋白表达阳性组复发率为28.3%,阴性组复发率为19.2%,两组差异无统计学意义;复发组PCNA-LI值为0.448±0.130,而无复发组为0.358±0.147,两组差异有统计学意义;复发组DNA异倍体率50%,无复发组23.2%,差异有统计学意义;复发组SPF为6.98±4.64,无复发组为4.70±2.49,两组差异有统计学意义。包膜完整组与不完整组间,PCNA和流式细胞检测结果差异分别有统计学意义;而在骨正常或压迫组、骨破坏组与骨侵蚀组间,大小肿物组间,细胞密集组与稀少组间,高低核分裂相组间,上述结果差异无统计学意义。结论腱鞘巨细胞瘤的复发与其内部细胞的高增殖活性有关。无明显包膜的肿物具有更高的内在增殖活性,复发率更高;

Objective A retrospective study of GCTTS in the hand was undertaken to determine whether specific clinic or pathologic factors were associated with an increased risk of recurrence, and to investigate the relationship between the recurrence of GCTTS and its biological indices. Methods 83 patients with histologically proven GCTTS were treated and followed up. The clinical materials were reviewed. Comparison was made between certain factors to determine which were associated with increased recurrence rates. Results The patients were followed for an average of 55 months. 22 patients (26.5%) recurred. Age, gender, site, the origin of tumors, size, bone erosion or destruction, cellularity and the mitoses were not risk factors for recurrence. Tumors without capsule had higher recurrence rate than that with capsule, and the difference was highly significant. The local recurrence rate of Nm23 positive group was 28.3%, and Nm23 negative group was 19.2%, there was no remarkable difference between the groups. The PCNA-LI was 0.448±0.130 in recurrent group and 0.358±0.147 in nonrecurrent group, the difference was statistically significant. The aneuploidy DNA content was presented in 50% of the recurrent tumors, and in 23.2% of nonrecurrent ones. The SPF was 6.98±4.64 in recurrent group and 4.70±2.49 in nonrecurrent group. These values were also significantly different. PCNA-LI, the aneuploidy DNA content and SPF were significantly higher in group without capsule than those in group with capsule. These values were not different between tumors with and without bone destruction, large and small diameter, high and low cellular tumors, as well as high and low mitoses tumors. Conclusion The high proliferative indices of recurrent GCTTS may explain its aggressive biologic behavior. Tumors without capsule possess higher proliferative indices than the ones with capsule, and they have higher recurrent rate. The proliferative indices of the tumors with and without bone distruction are comparable, and the difference of the recurrence rate among groups is not significant.