过碘酸六胺银染色在涎腺基底细胞腺瘤与腺样囊性癌病理鉴别诊断中的应用

Application of periodic acid-silver methenamine staining in the pathological differential diagnosis of salivary basal cell adenoma and salivary adenoid cystic carcinoma

目的 探讨过碘酸六胺银(PASM)染色在涎腺基底细胞腺瘤(SBCA)与涎腺腺样囊性癌(SACC)病理鉴别诊断中的应用价值。方法 回顾性分析51例SBCA及40例SACC的临床病理资料,应用PASM染色观察肿瘤基底膜的完整性,免疫组化方法检测Ki-67、CK19、P63、SMA、CD117、S-100、β-catenin及LEF-1,荧光原位杂交(FISH)方法检测MYB-NFIB基因融合及CTNNB1基因扩增。结果 PASM染色结果显示,51例SBCA瘤巢周围基底膜均呈完整线性,而40例SACC中有39例(97.5%)出现大范围基底膜断裂、缺损;FISH检测结果显示,14例SACC中8例检测出MYB-NFIB基因融合(57.14%),2例SACC检测出CTNNB1基因扩增,而SBCA组未出现MYB-NFIB基因融合及CTNNB1基因扩增或缺失。结论 PASM染色能显示SBCA和SACC瘤巢周围基底膜完整性,是两者有效、可行的鉴别诊断指标,推荐常规运用。

Objective To explore the application value of periodic acid-silver methenamine(PASM) staining in the pathological differential diagnosis of salivary basal cell adenoma(SBCA) and salivary adenoid cystic carcinoma(SACC). Methods The clinical pathologic data of 51 patients with SBCA and 40 patients with SACC were analyzed retrospectively. PASM staining was used to examine the integrity of basement membrane in tumor. The expression of Ki-67, CK19, p63, SMA, CD117, S-100, β-catenin and LEF-1 was detected by immunohistochemistry. MYB-NFIB fusion and CTNNB1 amplification were detected by fluorescence in situ hybridization(FISH). Results PASM staining showed that the basement membrane around the neoplastic cell nests was intact in 51 patients with SBCA, while the basement membrane was fractured and defective in 39 patients with SACC. FISH detection showed MYB-NFIB gene fusion in 8 patients with SACC and CTNNB1 gene amplification in 2 patients with SACC, while the MYB-NFIB gene fusion and the amplification or deletion of CTNNB1 gene were not detected in the SBCA group. Conclusion PASM staining shows the integrity of the basement membrane around the neoplastic cell nests in SBCA and SACC, which is an effective and feasible indicator for pathological differential diagnosis, and so it is recommended to be routinely used.