促泌素在肾上腺原发肿瘤中的表达及其临床意义

Expression and significance of secretagogin in primary adrenal tumors

目的比较促泌素(secretagogin,SCGN)与传统神经内分泌标记物在肾上腺原发肿瘤中的表达差异。方法收集肾上腺原发肿瘤手术标本共37例,其中包括18例皮质腺瘤、3例皮质腺癌、16例嗜铬细胞瘤。同时选取5例正常肾上腺组织,5例肾透明细胞癌作为对照。所有标本均使用SCGN、PGP9.5、CD56、NSE、Syn及CgA进行免疫组织化学SP法染色。结果SCGN在全部5例正常肾上腺皮质均有表达,而在髓质不表达(P<0.01),其中在皮质的表达明显高于PGP9.5和CgA的表达(P均<0.01);全部18例皮质腺瘤均表达SCGN,且明显高于NSE(P<0.05)、PGP9.5和CgA(P均<0.01);肾上腺嗜铬细胞瘤中SCGN的阳性表达率仅为18.8%(3/16),明显低于其它标记物(P均<0.01)。SCGN在皮质腺瘤(18/18)中的表达明显高于嗜铬细胞瘤(3/16)(P<0.01),而PGP9.5和CgA在嗜铬细胞瘤(15/16,16/16)中的表达明显高于皮质腺瘤(3/18,1/18)(P均<0.01);CD56、NSE和Syn在皮质腺瘤、皮质腺癌和嗜铬细胞瘤中均有高表达,但两两组间比较均无统计学差异(P均>0.05)。SCGN在全部5例肾透明细胞癌中均不表达。结论SCGN对肾上腺皮质腺瘤有较高敏感性,其与嗜铬细胞瘤的标记物CgA和PGP9.5联合可在两者的诊断和鉴别诊断中发挥重要作用。

Objective To investigate the expression of secretagogin（SCGN） and traditional neuroendocrine markers and to explore the significance of SCGN in primary adrenal tumors.Methods Thirty-seven samples of primary adrenal tumors were collected,including 18 cases of adrenal cortical adenoma,3 adrenal cortical adenocarcinoma and 16 pheochromocytoma.At the same time,5 cases of normal adrenal and 5 cases of clear cell carcinoma in kidney were selected as controls.All specimens were detected by immunohistochemistry.Using the specific antibody for SCGN and 5 conventional neuroendocrine markers PGP9.5,CD56,NSE,Syn and CgA.Results SCGN staining was positive in all 5 cases of normal adrenal cortex,but not in medulla（P0.01）,more frequently than PGP9.5 and CgA（P0.01）.SCGN showed positive staining in all 18 cases of adrenal cortical adenoma,which was obviously higher than those of NSE（P0.05）,PGP9.5 and CgA（P0.01）.The positive rate of SCGN in pheochromocytoma was only 18.8%（3/16）less than those of the other markers（P0.01）.The positive rate of SCGN was significantly different between adrenal cortical adenoma（18/18） and pheochromocytoma（3/16）（P0.01）.Also,significant differences were seen in the positive rates of PGP9.5 and CgA between pheochromocytoma（15/16,16/16） and adrenal cortical adenoma（3/18,1/18）（P0.01）.Although the positive rates of CD56,NSE and Syn were higher in all primary adrenal tumors,there was no significant difference in pairwise comparison（P0.05）.All 5 cases of clear cell carcinoma in kidney did not express SCGN.Conclusion SCGN is a novel marker that may be useful in the diagnosis of adrenal cortical adenoma.A combination of SCGN,PGP9.5 and CgA could serve as diagnostic markers for distinguishing adrenal cortical adenoma from pheochromocytoma.