SMARCE1在透明细胞型脑膜瘤中的诊断意义

The role of SMARCE1 in the diagnosis of clear cell meningioma

目的探讨SMARCE1在透明细胞型脑膜瘤(CCM)中的表达情况,并评估其在与CCM形态学相似疾病中的鉴别诊断价值。方法收集2000年1月至2018年12月福建医科大学附属第一医院、山东省立医院、首都医科大学宣武医院、湖北省十堰市太和医院CCM共13份标本/11例,以及伴有透明细胞样形态的脑膜瘤17例、其他类型脑膜瘤782例,和其他具有透明细胞样形态的颅内肿瘤。将纳入病例石蜡组织制作成组织芯片,行SMARCE1、SSTR2、上皮细胞膜抗原(EMA)、Ki-67、p53的免疫组织化学染色以及过碘酸-雪夫反应(PAS)、淀粉酶消化PAS(D-PAS)组织化学染色。结果CCM肿瘤细胞呈片状生长,无特殊排列方式,未见典型旋涡状结构,细胞多角形,胞质透亮,富含糖原,间质及血管周见多少不等的红染的胶原成分。免疫组织化学染色CCM均显示SMARCE1表达缺失(13/13),其他类型脑膜瘤(782/782,100%)均显示SMARCE1细胞核不同程度阳性,其中7例为部分弱阳性。伴有透明细胞样形态的脑膜瘤(17/17)均显示SMARCE1细胞核阳性。颅内转移性透明细胞性肾细胞癌(10/10)、血管母细胞瘤(10/10)、中枢神经细胞瘤(10/10)、少突胶质细胞瘤(10/10)、室管膜瘤(13/13)、胶质母细胞瘤(42/42,100%)、孤立性纤维性肿瘤/血管外皮瘤(35/35,100%)均无SMARCE1的丢失。CCM中SSTR2、EMA均阳性表达,Ki-67阳性指数1%~5%,p53阳性率0~40%。PAS染色显示CCM(13/13)以及伴有透明细胞样形态的脑膜瘤(17/17)均为胞质颗粒状阳性,D-PAS染色均阴性。结论SMARCE1可以作为CCM诊断及鉴别诊断有实用价值的重要参考标志物。

Objective To analyze the expression of SMARCE1 in clear cell meningioma(CCM),and evaluate the role of SMARCE1 in the differential diagnosis in morphologically similar diseases.Methods Thirteen samples/11 cases of CCMs were collected from the First Affiliated Hospital of Fujian Medical University,Shandong Provincial Hospital,Xuanwu Hospital of Capital Medical University and Thaihe Hospital of Hubei Province from January 2000 to December 2018,as well as 17 cases of meningiomas with clear-cell-like morphology,782 cases of other types of meningiomas and other intracranial tumors with clear-like morphology.A tissue microarray was made using these cases,on which immunohistochemical/histochemical staining of SMARCE1,SSTR2,EMA,Ki-67,p53,PAS and D-PAS were performed.Result The tumor cells of CCM had sheet-like architecture,without typical whorl formation.The CCM had round to polygonal cells,with clear,glycogen-rich cytoplasm and prominent blocky perivascular and interstitial collagen.The immunohistochemistry staining showed that none of the CCMs expressed SMARCE1(0/13).However,all of the other types of lesions,including meningioma(782/782),meningiomas with clear-like morphology(17/17),intracranial metastatic clear cell renal cell carcinoma(10/10),haemangioblastoma(10/10),central neurocytoma(10/10),oligodendroglioma(10/10),ependymoma(13/13),lioblastoma(42/42),and solitary fibrous tumor/hemangiopericytoma(35/35)showed positive nuclear staining of SMARCE1.Ki-67 index were 1%-5%,and p53 positive-rate were 0-40%in CCMs.PAS stain showed cytoplasmic granular positive and D-PAS were negative in all CCMs and meningiomas with clear-like morphology.Conclusion SMARCE1 is a useful marker for the diagnosis of CCM and its mimickers.