D2-40/S100、CD34/S100检测在皮肤恶性黑素瘤脉管转移诊断中的应用

Application of D2-40/S100 and CD34/S100 detection in the diagnosis of blood and lymphatic vessel invasion of cutaneous malignant melanoma

目的 探讨皮肤恶性黑素瘤（CMM）脉管微转移的免疫组化检测方法及临床意义.方法 经组织病理检查证实的CMM患者53例,男32例,女21例.年龄52 ～ 72（61.2＆#177;8.4）岁.每例取肿瘤中心部位的瘤组织,部分病例包括清扫淋巴结标本.平均随访时间（65.00＆#177;5.68）个月.随访期间17例患者死于CMM复发或转移,6例失访.采用组合式单克隆抗体和双酶标记的免疫组化鸡尾酒法检测53例CMM标本,在同一张组织切片上检测D2-40、S100、CD34抗原的表达情况.结果 53例CMM患者,HE染色＋组合式单克隆抗体阳性16例（30.19％）,双酶标记的免疫组化鸡尾酒法阳性26例（49.06％）,两种方法的阳性率差异有统计学意义（x2=3.94,P＜ 0.05）.血管淋巴管瘤栓组26例中21例（80.77％）、无瘤栓组27例中10例（37.04％）有淋巴结转移,两组差异有统计学意义（x2=10.43,P＜0.001）;血管淋巴管瘤栓组与同期无血管淋巴管瘤栓组5年生存率分别为42.31％（11/26）与70.37％（19/27）（x2=4.25,P＜ 0.05）.结论 免疫组化鸡尾酒法检测在诊断血管和淋巴管瘤栓上优于HE＋组合式单克隆抗体检查,血管和淋巴瘤栓是CMM患者的重要预后因素.

Objective To develop an immunohistochemical assay for the diagnosis of cutaneous malignant melanoma （CMM） micrometastasis via blood and lymphatic vessels,and to evaluate its clinical significance.Methods Fifty-three patients （32 males and 21 females） histopathologically diagnosed as CMM were enrolled in this study.The patients were aged （61.2 ＆#177; 8.4） years （range,52-72 years）.Tissue specimens were obtained from the central area of tumor in each case,and also from removed lymph nodes in some cases.The average duration of follow-up was （65.00 ＆#177; 5.68） months.During the follow-up,17 patients died of the recurrence or metastasis of CMM,and 6 patients were lost to follow-up.The expressions of D2-40,S100 and CD34 antigens in 53 tissue specimens were examined by immunohistochemical staining with three individual monoclonal antibodies,or by an immunohistochemical method using 2 two-antibody cocktails （D2-40/S 100 and CD34/S100） and double-color chromogens in single tissue sections.Results Of the 53 patients,30.19% （16/53） were positive for hematoxylin-eosin （HE） staining combined with immunohistochemical staining with individual monoclonal antibodies,and 49.06% （26/53） for the immunohistochemical method using two-antibody cocktails and double-color chromogens.Statistical differences were found in the positive rate between the two methods （x2 =3.94,P〈 0.05）.Compared with patients without blood/lymph vessel tumor emboli,those with blood/lymph vessel tumor emboli showed higher lymph node metastasis rate （80.77% （21/26） vs.37.04% （10/27）,x2 =10.43,P 〈 0.001）,but lower five-year survival rate （42.31% （11/26） vs.70.37% （19/27）,x2 =4.25,P 〈 0.05）.Conclusions The immunohistochemical method with two-antibody cocktails is superior to HE staining combined with immunohistochemical staining with individual monoclonal antibodies in the detection of blood/lymph vessel tumor emboli.And blood/lymph vessel tumor emboli may be an important prognostic factor in patients with CMM.