MDM2、CDK4和SATB2对诊断低级别骨肉瘤的价值  

Value of MDM2, CDK4 and SATB2 immunohistochemistry in histologic diagnosis of low-gradeosteosarcoma

作　　者：陈春燕[1] 张惠箴[1] 蒋智铭[1] 周隽[1] 陈杰[1] 刘亮[1] 

机构地区：[1]上海交通大学附属第六人民医院病理科,200233

出　　处：《中华病理学杂志》2016年第6期387-392,共6页Chinese Journal of Pathology

基　　金：上海交通大学医学院科技基金（14XJ10078）

摘　　要：目的探讨MDM2、CDK4和SATB2免疫标志物对低级别骨肉瘤的病理诊断价值。方法收集上海交通大学附属第六人民医院2002年1月至2015年6月20例低级别中央性骨肉瘤和27例骨旁骨肉瘤，观察其临床、影像及病理形态特征，用免疫组织化学法分析MDM2、CDK4和SATB2表达的敏感性和特异性，以及它们在低级别骨肉瘤与纤维结构不良、纤维瘤病及低级别纤维肉瘤等纤维性肿瘤中表达的差异性。结果低级别骨肉瘤病程长，发病年龄大，主要位于长骨；影像学上低级别中央性骨肉瘤以恶性溶骨性改变为主，但5／18的病例其影像改变与中间型和良性骨病重叠；骨旁骨肉瘤以恶性硬化性改变为主。组织形态上分化良好的梭形肿瘤细胞和分化成熟、形态各异的瘤骨以浸润性生长为主要特征；免疫标志物MDM2和CDK4在低级别骨肉瘤中的阳性表达率分别为74．5％（35／47）和55．3％（26／47），83．0％（39／47）的病例至少表达其中1种；低级别骨肉瘤和纤维结构不良都表达SATB2，而纤维瘤病、低级别纤维肉瘤等纤维性肿瘤阴性。结论MDM2、CDK4以及SATB2的免疫标记结果受标本脱钙、抗体来源及实验条件等多种因素影响，低级别骨肉瘤的诊断仍要依靠临床、影像和病理三结合来综合判断，以MDM2和／或CDK4阳性作为支持低级别骨肉瘤的辅助诊断指标，但阴性不能排除诊断；SATB2阴性有助于排除骨原发性纤维性肿瘤，但不包括纤维结构不良。Objective To investigate the value of combined application of MDM2, CDK4 and SATB2 immunohistochemistry in pathological diagnosis of low-grade osteosarcoma~ Methods Forty-seven cases of low grade osteosarcoma, including low grade central osteosarcoma （ n = 20 ） and parosteal osteosarcoma （ n = 27 ）, were selected from Shanghai Jiaotong University Affiliated the Sixth People＇ s Hospital. The clinical, radiography and histopathology were reviewed. The sensitivity and specificity of MDM2, CDK4 and SATB2 immunohistochemistry in the diagnosis of low-grade osteosarcoma were assessed along with an evaluation of their expressions in fibrous dysplasia, desmoplastic fibroma, low-grade fibrosarcoma and other fibrous tumors. Results Low-grade osteosarcoma had protracted clinical course, occurring mostly in elder adults and mainly involving long bones. Radiographic studies showed that low-grade central osteosarcoma had a mainly malignant lytic presentation, however about 5/18 of tumors overlapping with intermediate and benign bone diseases, while parosteal osteosarcoma was characterized by a densely sclerotic malignant appearance. Histologically, low-grade osteosarcomas were characterized by well- differentiated spindle tumor cells, various mature tumor bones and an aggressive growth pattern. The positive expression rates of MDM2 and CDK4 in low-grade osteosarcoma were 74. 5% and 55.3%, respectively. Eighty-three percent of low-grade osteosarcoma expressed one or both markers. Low-grade osteosarcoma and fibrous dysplasia were both positive for SATB2, while desmoplastic fibroma, low-grade fibrosacoma and other fibrous tumors were negative for SATB2. Conclusions Accurate diagnosis of low-grade osteosarcoma should be based on combination of clinical presentation, imaging and histopathology, with immunohistochemistry as a diagnostic adjunct. Positive immunostaining for CDK4 and/or MDM2 supports the diagnosis of low-grade osteosarcoma, but the negative one does not rule out such lesion. The negative expression of SATB2 i

关 键 词：骨肉瘤 原癌基因蛋白质c-mdm2 细胞周期蛋白依赖激酶4 免疫组织化学 

分 类 号：R738.1[医药卫生—肿瘤]