联合检测SALL4、OCT3/4、CD117和glypican-3在恶性生殖细胞肿瘤诊断及分型中的应用  

Combined utilization of SALL4,OCT3/4,CD117 and glypican-3 immunostaining in the diagnosis and classification of malignant germ cell tumors

作　　者：郭韦韦[1] 敖启林[2] 彭晓蓉[1] 董华[1] Guo Weiwei;Ao Qilin;Peng Xiaorong;Dong Hua(Department of Pathology, Gongan County People’s Hospital of Hubei province, Hubei Gongan, 434300;Institute of Pathology,Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China)

机构地区：[1]湖北省公安县人民医院病理科,公安434300 [2]华中科技大学同济医学院附属同济医院病理学研究所,武汉430030

出　　处：《中国组织化学与细胞化学杂志》2017年第6期577-583,共7页Chinese Journal of Histochemistry and Cytochemistry

摘　　要：目的探讨联合检测SALL4、OCT3/4、CD117和glypican-3在恶性生殖细胞肿瘤(malignant germ cell tumors,MGCTs)诊断和分型中的应用价值。方法采用免疫组织化学Envision法检测117例MGCTs中SALL4、OCT3/4、CD117和Glypican-3的表达情况,包括25例精原细胞瘤、12例无性细胞瘤、20例生殖细胞瘤、18例胚胎性癌、42例卵黄囊瘤,另选取24例非生殖细胞恶性肿瘤作为对照,包括8例卵巢透明细胞癌,6例卵巢浆液性癌,5例胸腺癌,5例淋巴瘤。结果SALL4在全部MGCTs中均呈细胞核弥漫强阳性表达;OCT3/4在精原细胞瘤(24/25)、无性细胞瘤(11/12)、生殖细胞瘤(19/20)以及全部胚胎性癌(18/18)中呈细胞核阳性表达,在卵黄囊瘤均阴性;CD117在精原细胞瘤(23/25)、无性细胞瘤(11/12)、生殖细胞瘤(18/20)以及部分卵黄囊瘤(26/42)中呈不同程度的细胞膜阳性表达,仅在少数(2/18)胚胎性癌呈灶性表达;glypican-3在卵黄囊瘤(37/42)中瘤细胞的细胞质表达,另在(3/18)例胚胎性癌、(1/12)例无性细胞瘤呈灶性表达。24例对照中,SALL4、OCT3/4均为阴性,CD117在1例卵巢浆液性癌和1例胸腺癌中呈灶性表达,glypican-3在1例卵巢透明细胞癌中呈灶性表达,其余肿瘤CD117、glypican-3均阴性。结论 SALL4可作为MGCTs病理诊断的通用免疫标记物,OCT3/4和CD117有助于精原细胞瘤、无性细胞瘤、生殖细胞瘤以及胚胎性癌的诊断和鉴别诊断,glypican-3和CD117阳性有助于卵黄囊瘤的诊断。联合检测这4个抗体在MGCTs的病理诊断和分型中有很高的临床应用价值,可作为一线抗体组合推广运用。Objective To investigate the value of combined detection of SALL4,OCT3/4,CD117,and Glypican-3in the diagnosis and classification of malignant germ cell tumors(MGCT).Methods The expressions of SALL4,OCT3/4,CD117,and Glypican-3proteins were detected by EnVision immunohistochemical method in117cases of MGCT,including25cases of seminomas,12cases of dysgerminomas,20cases of germinomas,18cases of embryonal carcinomas(EC),and42cases of yolk sac tumors(YST).Twenty four cases of malignant non-germ cell tumors were selected as a control group,including8ovarian clear cell carcinomas(CCC),6ovarian serous carcinomas(SC),5thymic carcinomas,and5lymphomas.Results SALL4showed strong and diffusive expression in nucleus of all MGCTs cases.OCT3/4nucleus staining was positive in seminomas(24/25),dysgerminomas(11/12),germinomas(19/20)and all EC(18/18),but negative in all42YSTs.The membranous expressions of CD117in seminomas(23/25),dysgerminomas(11/12),germinomas(18/20)and YST(26/42)were positive but variable,while the staining was more focal in2of18EC.Glypican-3staining in the cytoplasm was seen in37YSTs,3ECs,and1dysgerminoma with a focal pattern in the last two tumor types.In contrast,SALL4and OCT3/4were all negative in24control cases.All tumors were negative for CD117and Glypican-3staining except1SC and1thymic carcinoma were CD117positive and1CCC was Glypican-3positive with all three showing a focal staining.Conclusion SALL4can be used as a universal immunological marker for pathological diagnosis of MGCTs clinically.OCT3/4and CD117show added value in the diagnosis and differential diagnosis of seminoma,dysgerminoma,germinoma and embryonal carcinoma.Positive Glypican-3and CD117staining can be an indicator for the diagnosis of yolk sac tumors.The combination of SALL4,OCT3/4,CD117,and Glypican-3immunostaining has a high clinical value for pathological diagnosis and classification of MGCTs,therefore corresponding antibodies can be used for first-line detection.

关 键 词：生殖细胞肿瘤 SALL4 OCT3/4 CD117 GLYPICAN-3 病理诊断 免疫组织化学 

分 类 号：R730.43[医药卫生—肿瘤]