嗅神经母细胞瘤的病理形态特点及其诊断和鉴别诊断  

Study on pathological features and diagnosis, differential diagnosis of olfactory neuroblastoma

作　　者：刘红刚[1] 张盛忠[1] 何春燕[1] 

机构地区：[1]首都医科大学附属北京同仁医院,100730

出　　处：《中华病理学杂志》2003年第5期432-436,共5页Chinese Journal of Pathology

基　　金：卫生部优秀青年课题基金资助项目 ( 96 0 0 59)

摘　　要：目的　总结嗅神经母细胞瘤 (ONB)的病理形态学特点 ,评价各种方法的诊断价值 ,并结合其他辅助检查确定与鼻腔鼻窦其他小细胞恶性肿瘤的鉴别诊断依据 ,提高ONB的病理诊断水平。方法　收集ONB 3 4例 ,鼻腔鼻窦的横纹肌肉瘤 (RMS) 11例、淋巴瘤 76例。对病例基本情况进行了统计 ,对其活检标本进行了如下处理和观察 :(1)常规HE染色、光镜观察。 (2 )免疫组织化学染色 (两步聚合物检测PV60 0 0法 )及观察。ONB病例标记了神经元特异性烯醇化酶 (NSE) ,嗜铬素A(CgA) ,S 10 0蛋白 ,细胞角蛋白 (AE1/AE3 ) ,白细胞共同抗原 (LCA) ,结蛋白 ,横纹肌肌动蛋白 (S actin)。RMS病例标记了结蛋白、肌球蛋白、S actin及NSE、CgA及LCA。淋巴瘤病例标记了LCA ,T细胞标记物 (CD45RO) ,B细胞标记物 (CD2 0 )及NK细胞标记物 (CD56)。另对 10例NK /T细胞型淋巴瘤、9例B细胞型淋巴瘤标记了NSE、CgA、结蛋白及S actin。 (3 )透射电镜观察。对ONB、RMS及淋巴瘤各 4例进行了透射电镜观察。结果　ONB与RMS及淋巴瘤发病均主要为中青年 ,临床局部表现有相似之处。ONB的形态学特征是 :上皮团巢 ,血管袢网隔 ,小圆小梭形细胞及细胞核 ,腺样及鳞状上皮样细胞 ,菊形团 ,神经丝束 ,深染的细胞核 ,少、粉染或透明的胞质。免疫组织化学标记结?Objective To observe the common characteristics of pathological morphology and immunohistochemical staining of olfactory neuroblastoma (ONB), and to raise the diagnostic ability for ONB. Methods 34 cases of ONB, 11 cases of rhabdomyosarcoma (RMS) and 76 cases of malignant lymphoma (ML) were collected, the clinical information were investigated, and the biopsy samples were stained and observed as follows: (1)Routine HE staining and viewed under the light microscope. (2) Expression of neuron-specific enolase (NSE), chromogranin-A (CgA), leukocyte common antigen (LCA), desmin, and sarcometic actin (S-actin) were determined in both ONB and RMS cases. In addition, S-100 protein, cytokeratin (AE1/AE3) were detected in the ONB and myoglobulin detected in the RMS. ML samples were stained for LCA, CD45RO, CD56, and CD20. The NSE, CgA, desmin and S-actin were stained in 10 cases of NK/T cell ML and 9 cases of B cell ML addit ionally. (3) 4 cases of ONB, RMS and ML were observed under transmission electron microscope respectively. Results The ages and clinical manifestations of ONB, RMS and ML were similar. The morphological characteristics of ONB included epithelial nests; net of angioma-like fibrous connective tissues; small round cells and small short spindle cells and nucleus; glandular and squamous liked epithelium; Homer-Wright and Flexner rosette; bunch of neurofibrilla, etc. NSE and CgA were expressed in small cells. S-100 protein was positive in the area of bunch of neurofibrilla. AE1/AE3 was positive in epithelial cells, LCA, while desmin and S-actin were all negative. Ultrastructurelly, there were neurosecretory granules and neurofibrilla in the cytoplasm of a few tumor cells. Although there were some similarities among ONB, RMS and ML under the light microscope, their characteristics of pathologic morphology, immunohistochemical staining and transmission electron microscope were different. Conclusions The features of the morphological changes are the most important basis to make diagnosis for ONB. The result

关 键 词：淋巴瘤 结蛋白 NSE 鉴别诊断 嗅神经母细胞瘤 免疫组织化学 表达 细胞核 微丝 超微结构特征 

分 类 号：R730.4[医药卫生—肿瘤]