Pan-TRK免疫组化在涎腺分泌性癌中敏感性与特异性的临床病理分析

Sensitivity and specificity of Pan-TRK immunohistochemistry in secretory carcinoma of salivary glands:a clinicopathological study

目的探讨Pan-TRK免疫组化在涎腺分泌性癌(secretory carcinoma of salivary glands,SCSG)诊断及鉴别诊断中的价值。方法收集14例SCSG临床资料,采用免疫组化、FISH对SCSG进行检测。另选取经典的腺泡细胞癌、黏液表皮样癌、腺样囊性癌各10例作为对照。结果14例SCSG患者男女比为4∶3,年龄15~79岁,10例发生于腮腺,2例发生于颊部,1例发生于腭部,1例发生于颈部;11例生存状态良好,1例复发生存,2例失访。14例SCSG,多呈浸润性生长,呈微囊状、乳头-囊状、管状、实性排列或几者混合,腔内伴丰富分泌物,1例见神经侵犯,1例伴淋巴结转移。免疫表型:14例SCSG中CK7、S-100、Mammaglobin均阳性,11例SOX-10阳性,10例GATA-3阳性,14例DOG1均阴性,Ki-67增殖指数为1%~15%。FISH检测:12例SCSG成功检测到FISH信号,10例发现ETV6-NTRK3基因融合阳性。14例SCSG均行Pan-TRK免疫组化检测,10例细胞核阳性,1例细胞质阳性。10例腺泡细胞癌、10例黏液表皮样癌、10例腺样囊性癌中分别有2、4、7例Pan-TRK阳性,定位于细胞膜/细胞质。结论Pan-TRK免疫组化阳性可提示伴ETV6-NTRK3融合的SCSG,尤其以细胞核着色模式为阳性标准时,在SCSG诊断及鉴别诊断中表现为较高的敏感性和高度特异性,并对未来TRK基因靶向治疗提供依据。

Purpose To explore the value of Pan-TRK immunohistochemistry in the pathological diagnosis and differential diagnosis of secretory carcinoma of salivary glands(SCSG).Methods All the 14 cases of SCSG underwent clinical data collection,histological observation,immunohistochemical staining,and ETV6-NTRK3 fusion gene probe detection.In addition,10 cases of classic acinar cell carcinoma,mucoepidermoid carcinoma,and adenoid cystic carcinoma were selected as controls.Results The ratio of male to female in 14 patients with SCSG was 4∶3,aged 15-79 years.10 cases occurred in the parotid gland,2 cases in the cheek,1 case in the palate,and 1 case in the neck.Of 14 SCSG cases,11 cases were in good survival status,1 case survived recurrence,and 2 cases were lost to follow-up.In 14 cases of SCSG,most of them were infiltrative growth,arranged in microcystic,papillary-cystic,tubular,solid or mixed patterns,with abundant secretions,nerve invasion in 1 case,and lymph node metastasis in 1 case.All 14 SCSG cases expressed CK7,S-100 and mammaglobin,11 expressed SOX-10,10 expressed GATA-3,all were negative for DOG1,and the Ki-67 index was 1%-15%.Of the 12 SCSG cases for which signals were successfully detected,10 were positive for the ETV6-NTRK3 fusion.Pan-TRK immunohistochemical detection was performed in all 14 cases of SCSG,10 cases were positive in the nucleus and 1 case was positive in the cytoplasm.10 cases of acinar cell carcinoma,mucoepidermoid carcinoma,and adenoid cystic carcinoma showed positive expression in 2 cases,4 cases,and 7 cases,respectively,all of which were located in the cell membrane/cytoplasm.Conclusion Positive Pan-TRK immunohistochemistry can indicate the SCSG with ETV6-NTRK3 fusion,and especially when nuclear staining is used as the positive standard,it has high sensitivity and high specificity in the pathological diagnosis and differential diagnosis of SCSG,and it provides data for future TRK gene targeted therapy.