BMP及其受体在纤维母细胞型骨肉瘤和恶性纤维组织细胞瘤中的表达及鉴别诊断意义

Expression of bone morphogenetic protein and its receptor in fibroblastic osteosarcoma and malignant fibrous histiocytoma and its significance in differential diagnosis

目的探讨骨形态发生蛋白(bone morphogenetic protein,BMP)及其受体(BMPRII)在纤维母细胞型骨肉瘤和恶性纤维组织细胞瘤中的表达差异,及其对两者病理鉴别诊断的意义。方法采用免疫组化EnVision两步法对10例纤维母细胞型骨肉瘤和10例恶性纤维组织细胞瘤行BMP2/4和BMPRII染色,并对比观察。结果 10例纤维母细胞型骨肉瘤平均年龄为27.7岁,均位于长骨干骺端,免疫组化标记8例可同步检测到BMP2/4和BMPRII的阳性表达。10例MFH平均年龄为48.5岁,7例位于长骨干骺端、2例位于长骨骨干、1例位于大腿软组织,免疫组化标记8例可检测到BMP2/4的阳性表达,但均不表达BMPRII。两者镜下均以高级别的梭形细胞肉瘤成分为主,但纤维母细胞型骨肉瘤中有肉瘤细胞直接形成的骨样基质,而MFH无成骨。结论纤维母细胞型骨肉瘤能同步表达BMP2/4和BMPRII,而MFH只表达BMP2/4、不表达BMPRII,这可能是MFH肿瘤细胞缺乏形成骨样基质能力的原因,同时也为两者的鉴别诊断提供了有价值的客观指标。

Purpose To investigate the expression of bone morphogenetic protein and its receptor in fibroblastic osteosarcoma and malignant fibrous histiocytoma（MFH） and its significance for their differential diagnosis.Methods Ten cases of fibroblastic type osteosarcoma and 10 cases of MFH were studied by light microscopy and immunohistochemistry.Results The mean age of 10 cases of fibroblastic osteosarcoma was 27.7 and they all located in the metaphysis of long tubular bones.BMP2/4 and BMPRII were simultaneously stained positively in 8 cases.However,10 cases of MFH had a mean age of 48.5 years.7 of 10 cases occurred in the metaphysis of long tubular bones,two in the diaphysis of long tubular bones and one in the soft tissues of thigh.The tumor cells stained positively for BMP2/4 in 8 cases,but stained negatively for BMPRII in all cases.Under light microscope,the main component of fibroblastic osteosarcoma and MFH were high-grade spindle cell sarcoma,and their key difference was the formation of osseous matrix in osteosarcoma but absent in MFH.Conclusions BMP2/4 and BMPRII are simultaneously detected in fibroblastic osteosarcoma,but MFH expresses BMP2/4 but not BMPRII,which may explain the reason why MFH tumor cells do not ossify.At the same time,this expression difference provides a useful indicator for their differential diagnosis.