CD200和INSM1在胃肠胰神经内分泌肿瘤中的表达及其病理诊断价值  

Expression of CD200 and INSM1 in gastrointestinal and pancreatic neuroendocrine neoplasms and its diagnostic values

作　　者：曹钟[1] 岑红兵 魏建国[2] 秦灵芝 廖伟 敖启林[3] Cao Zhong;Cen Hongbing;Wei Jianguo;Qin Lingzhi;Liao Wei;Ao Qilin(Department of Pathology,Hubei Huanggang Central Hospital,Huanggang 438000,Hubei Province,China;Department of Pathology,Shaoxing People′s Hospital,Zhejiang Province,Shaoxing 312000,China;Institute of Pathology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Respiratory,the Fifth Hospital in Wuhan,Wuhan 430050,China)

机构地区：[1]湖北省黄冈市中心医院病理科,438000 [2]浙江省绍兴市人民医院病理科,312000 [3]华中科技大学同济医学院附属同济医院病理研究所/同济医学院病理学系,武汉430030 [4]湖北省武汉市第五医院呼吸内科,430050

出　　处：《中华病理学杂志》2021年第10期1134-1138,共5页Chinese Journal of Pathology

摘　　要：目的探讨CD200和胰岛素瘤相关蛋白1(INSM1)在胃肠胰神经内分泌肿瘤(NEN)中的表达及病理诊断价值。方法采用免疫组织化学方法在69例胃肠胰NEN,66例胃肠胰非NEN和16例转移性NEN中检测CD200、INSM1、突触素和嗜铬粒素A(CgA)的表达情况,并通过绘制受试者工作特征(ROC)曲线,比较CD200、INSM1、突触素和CgA及其组合在胃肠胰NEN中的病理诊断价值。结果CD200的阳性信号位于肿瘤细胞胞质和/或胞膜,CD200在胃肠胰NEN和非NEN中的阳性表达率差异有统计学意义(P<0.01)。CD200对诊断胃肠胰NEN的灵敏度为95.7%,特异度为78.8%。CD200在神经内分泌瘤和神经内分泌癌中的阳性率差异有统计学意义(P=0.05)。INSM1阳性信号位于肿瘤细胞核,INSM1在胃肠胰NEN和非NEN中的阳性表达率差异有统计学意义(P<0.01)。INSM1对诊断胃肠胰NEN的灵敏度为85.5%,特异度为95.5%。INSM1在神经内分泌瘤和神经内分泌癌中的阳性率,在神经内分泌瘤G1和G3中的阳性率差异均有统计学意义(P<0.05)。单项检测CD200、INSM1、突触素和CgA ROC曲线下面积(0.857、0.907、0.890和0.833)差异无统计学意义(P>0.05)。联合检测CD200+INSM1的灵敏度明显高于突触素+CgA(85.5%比63.8%,P<0.05),两种组合的ROC曲线下面积分别为0.962和0.925,两者间的差异无统计学意义(P>0.05)。结论CD200和INSM1是两种新型NEN标志物,有助于胃肠胰NEN的诊断和排除其相似的肿瘤,并且可以提示肿瘤的分化级别。联合检测CD200和INSM1作为免疫组织化学小组时具有高灵敏度和特异度,可以作为突触素和CgA有用的补充。Objective To investigate the expression and diagnostic values of CD200 and insulinoma associated protein 1(INSM1)in gastrointestinal and pancreatic neuroendocrine neoplasm(GIP-NEN).Methods The expression of CD200,INSM1,Syn and CgA was detected in 69 cases of GIP-NEN,66 cases of gastrointestinal and pancreatic non-neuroendocrine neoplasm(GIP-nonNEN)and 16 cases of metastatic neuroendocrine neoplasm by immunohistochemistry,to compare the values of CD200,INSM1,Syn,CgA and their combinations in diagnosing GIP-NEN.Receiver operating characteristics(ROC)curve was used.Results The immunoreactivity of CD200 was present in the cytoplasma and/or membrane of the neoplasms cells,the positive expression rates in GIP-NEN and GIP-nonNEN were significantly different(P<0.01).The sensitivity and specificity of CD200 for diagnosing GIP-NEN were 95.7%and 78.8%,respectively.There was significant difference of the positive rates of CD200 between neuroendocrine tumor and neuroendocrine carcinoma(P=0.05).The immunoreactivity of INSM1 was present in the nuclei of neoplasms cells.The positive expression rates in GIP-NEN and GIP-nonNEN were significantly different(P<0.01).The sensitivity and specificity of INSM1 for diagnosis of GIP-NEN were 85.5%and 95.5%,respectively.There were also significantly different positive rates of INSM1 between neuroendocrine tumor and neuroendocrine carcinoma,as well as between G1 and G3 neuroendocrine tumors(P<0.05).There was no difference in the area under ROC curve(AUC)of single stain of CD200,INSM1,Syn or CgA(0.857,0.907,0.890 and 0.833,respectively,P>0.05).The sensitivity of combined CD200+INSM1 stains for diagnosing GIP-NEN was significantly higher than that of Syn+CgA(85.5%vs.63.8%,P<0.05).The AUC of two combinations were 0.962 and 0.925,respectively,which were not statistically different(P>0.05).Conclusions CD200 and INSM1 are two novel markers of neuroendocrine neoplasm,which aid to diagnosis for GIP-NEN and exclude its mimickers.They are associated with tumor grades.Combining both as an immunohistoch

关 键 词：胃肠肿瘤 神经内分泌瘤 癌 神经内分泌 诊断 鉴别 免疫组织化学 胰岛素瘤相关蛋白1 

分 类 号：R735[医药卫生—肿瘤]