肾上腺肿瘤鉴别诊断的免疫组织化学研究

Application of immunohistochemistry in differential diagnosis of adrenal gland neoplasm

目的 探讨免疫组化在肾上腺肿瘤鉴别诊断上的应用。方法 运用免疫组化方法对肾上腺皮质肿瘤和嗜铬细胞瘤进行内皮素 (ET) 1、嗜铬蛋白 (Cg)A、神经特异性烯醇化酶 (NSE)、蛋白基因产物 (PGP) 9 5、突触素 (Syn)及突触小泡蛋白 (SV2 )检测。结果 10 0 %肾上腺皮质和皮质腺瘤ET 1染色阳性 ,阳性物以环状和颗粒状存在于瘤细胞胞浆内 ,30 .0 %皮质腺癌和 12 5 %嗜铬细胞瘤也含少许ET 1阳性细胞 ,但免疫反应物呈粉尘状。CgA仅出现在肾上腺髓质和嗜铬细胞瘤的细胞浆内。NSE几乎出现在所有病例中。Syn和PGP9 5多见于癌和所有嗜铬细胞中。SV2 主要见于正常皮质和所有嗜铬细胞瘤。结论 CgA阴性 ,ET 1阳性免疫反应物为环状、颗粒状的肿瘤可能为皮质腺瘤。CgA阴性 ,NSE、PGP9 5、Syn或SV2 阳性 ,ET 1阴性或瘤细胞胞浆内含粉尘状免疫反应物 ,可能是皮质腺癌。CgA和其他神经标记物阳性的肿瘤为嗜铬细胞瘤 ,但少数肿瘤也可见粉尘状ET

Objective To study the methodology of differential diagnosis of adrenal gland neoplasm. Methods Immunohistochemical technique was applied to detect the expression of endothelin-1 (ET-1), chromogranin A (CgA), synaptophysin (Syn), neuron-specific enolase (NSE), protein gene product (PGP) 9.5 and synaptic vesicle protein (SV)2 in routinely processed tissue specimens from human adrenal cortical neoplasm and pheochromocytoma. Results ET-1 immunireactivity was regularly seen in adrenal cortex and cortical adenoma, but not in the medulla. The immunoreactive materials appeared in the cytoplasm and in the form of vacuole or grains. Thirty percent of carcinomas and 12.5% pheochromocytomas showed ET-1 positive cells but there were few, appearing focally, and the ET-1 positive materials were'dust-like'. CgA only appeared in the all cases of medulla and pheochromocytoma. NSE was the most commonly occurring marker and detected in the cortex, adenomas, carcinomas and pheochromocytomas. Syn and PGP9.5 positive cells were prominent in the carcinomas and all cases of medulla and pheochromacytoma, while SV2 positivity was mainly found in normal cortex and all cases of medulla and pheochromacytoma. Conclusions Cortical adenomas contain ET-1+ materials in the form of vacuole or grains but CgA-. The other 4 antibodies are not useful in the differential diagnosis because of the possibility of neuroendocrine differentiation in the cortical neoplasm. Cortical carcinoma does not display CgA and ET-1 positive cells but contains NSE, PGP9.5, Syn or SV2 positive cells in some cases. CgA and other 4 neurogenic markers are demonstrated in pheochromocytomas.