良性和恶性嗜铬细胞瘤的区别  

Distinction between benign and malignant pheochromocytomas

作　　者：刘彤华[1] 陈原稼[2] 武莎菲[1] 高洁[1] 蒋卫君[2] 卢朝辉[1] 关键[1] 魏拴增[1] 罗玉凤[1] 曹金玲[1] 万建伟[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院病理科,100730 [2]中国医学科学院中国协和医科大学北京协和医院消化内科,100730

出　　处：《中华病理学杂志》2004年第3期198-202,共5页Chinese Journal of Pathology

摘　　要：目的　分析良性和恶性嗜铬细胞瘤在组织形态、免疫组织化学、DNA倍体、11q13和 1p的杂合子缺失 (LOH)及微卫星不稳定性 (MSI)方面的差别 ,试图找出能区别良、恶性或预测恶性潜能的指标。方法　对 2 2例临床确诊为良性 (12例 )或恶性 (10例 )的嗜铬细胞瘤 :(1)分析组织形态 ;(2 )免疫组织化学观察Ki 6 7、p5 3、嗜铬粒素A、S 10 0、增殖细胞核抗原及survivin表达 ;(3)用流式细胞术分析DNA倍体 ;(4 ) 12例附有正常组织的肿瘤 (7例良性 ,5例恶性 )用显微切割获取肿瘤和正常组织 ,分别提取DNA ;用 8种引物进行PCR扩增 ,分析 11q13和 1p的LOH及MSI。结果　全组 2 2例肿瘤均未见不典型核分裂象 ,核分裂象数除 1例恶性肿瘤为 2 3/ 10HPF外 ,余均≤ 1/ 10HPF ,2例恶性肿瘤有广泛坏死。良性组Ki 6 7阳性细胞百分率明显少于恶性组 ,良性与恶性组平均Ki 6 7阳性细胞百分率之比为 0 73%∶2 4 % ,差异有显著意义 ,DNA倍体良性与恶性组差异无显著性。 11q13和 1pLOHMSI良性和恶性组的差别由于例数少 ,未能达到统计学意义。结论　仅Ki 6 7阳性表达 >Objectives To investigate the differences in morphology, immunohistochemistry, DNA ploidy status, LOH and MSI of 11q13 and 1p between benign and malignant pheochromocytomas, and to find the marker or markers useful in distinction between benign and malignant pheochromocytoma or for predicting the malignant potential of this tumor. Methods Twenty-two cases of clinically documented benign and malignant pheochromocytomas from the files of Peking Union Medical College Hospital were analyzed. Aside from histological study, Ki-67, p53, CgA, S-100, PCNA and survivin immunohistochemistry studies were performed. DNA ploidy status was assessed by flow cytometry on cell suspensions prepared from formalin-fixed, paraffin-embedded sections. Twelve tumors (7 benign and 5 malignant) with paired normal tissues were microdissected. Tumor and normal tissue DNA were extracted. The obtained DNAs and 8 microsatellite markers related to 11q13 and 1q were subjected to PCR amplification for analysis of LOH and MSI. Results None of the tumors showed atypical mitosis, only 1 malignant tumor had a mitotic count >1/10 HPF(2.3/10 HPF). Two malignant tumors exhibited confluent necrosis. Ki-67 index was low in benign tumors(average 0.73%), and high in malignant tumors (average 2.4%). The difference of Ki-67 index between benign and malignant tumors was statistically significant. DNA ploidy status did not correlate with malignancy. Although LOH and/or MSI of 11q13 and 1p were observed in several tumors, a statistically significant difference could not be reached due to the small number of tumors analyzed. Conclusion Only Ki-67 index(>3%) is an useful marker for distinguishing benign from malignant or for predicting the malignant potential of pheochromocytoma.

关 键 词：良性嗜铬细胞瘤 恶性嗜铬细胞瘤 杂合子缺失 微卫星不稳定性 免疫组织化学 DNA倍体、 

分 类 号：R736[医药卫生—肿瘤]