胰腺实性-假乳头状瘤的临床病理及免疫组化分析

Clinicopathological and Immunohistochemical Analysis of Solid-pseudopapillary Neoplasm of Pancreas

【目的】分析胰腺实性-假乳头状瘤(SPN)的临床病理特征及免疫组织化学表达情况,寻找其相对特异的免疫组化诊断标记。【方法】HE染色观察10例病例形态学特征,免疫组织化学检测其细胞角蛋白、波形蛋白、CD56、CD10、嗜铬素A、突触素、神经元特异性烯醇酶、α-1抗胰蛋白酶、孕激素受体和E-钙粘素、β-连环蛋白及cyclinD1的表达。另选5例正常胰腺组织作对照。【结果】10例SPN中6例为女性,4例为男性,年龄17～41岁,平均29岁。全部病例随访至今均存活,未发生复发或转移。肿瘤组织囊实性外观,镜下呈实性假乳头状结构。10例中,Vim、CD56及PR均弥漫阳性,9例NSE(+),7例CD10(+),6例Syn(+),5例CK及α-AT(+),4例CgA(+)。5例正常胰腺组织E-cadherin与β-catenin均为细胞膜表达,且cyclinD1(-);在10例SPN中,均未见E-cadherin的胞膜表达,仅2例中少数肿瘤细胞核阳性;β-catenin为核/胞浆异常表达;且cyclinD1均为阳性。【结论】在SPN中,E-cadherin为阴性或胞核阳性,而β-catenin呈异常表达;SPN中Vim、CD56、PR、CD10阳性以及E-cadherin与β-catenin的表达情况为该肿瘤诊断相对特异的免疫组化指标。

[ Objective ] To analyze the clinlicopathological and immunohistochemical features of solid-pseudopapillary neoplasm of pancreas （SPN） in 10 cases and to investigate the relatively specific immunohistochemistrical markers used in pathological diagnosis. [Methods] Morphological features of 10 SPNs were observed after HE staining, and the expression of cytokeratin （Ck）, vimentin （Vim）, CD56, CD10, chromogranin （CgA）, synaptophysin （Syn）, neuron-specific enolase （NSE）, alpha-1-antitrypsin （α-AT）, progesterone receptor （PR）, E-cadherin, β-catenin, and cyclin D1 were detected by immunohistochemistry. In addition, 5 normal pancreases were taken as control. [Results] There were 6 females and 4 males in 10 SPNs, ranging in age from 17 to 41 years, with an average of 29 years. All the patients were alive till recent follow-up and no recurrence or metastasis was found. The tumors exhibited cystic-solid appearance, and showed solid-pseudopapillary structure microscopically. Vim, CD56, and PR were positive in all the 10 SPNs, NSE in 9 cases, CD10 in 7 cases, Syn in 6 cases, Ck and α-AT in 5 cases, and CgA in 4 cases. E- cadherin and β-catenin showed diffuse membranous reactivity in 5 normal pancreases with cyclin D1 negativity. In the 10 SPNs, membrane expression of E-cadherin was not observed in neoplastic cells. E-cadherin was only expressed positively in the nuclei of a few tumor ceils in 2 cases. The β-catenin expression was abnormal in nuclear and cytoplasm and each case showed nuclei reactivity for cyclin D1. [ Conclusions ] In SPN, E-cadherin is plasm-negative or nucleus-positive, while β-catenin expresses aberrantly. Positive expression of Vim, CD56, PR, CD10, and the expression of E-cadherin and β-catenin are relative specific immunohistochemical indexes for pancreas tumor diagnosis.