鼻颅底小圆细胞恶性肿瘤诊断中免疫组化指标的选择(1)
【摘要】 目的 探讨组织病理学为小圆细胞的各种鼻颅底恶性肿瘤的特征和诊断中免疫组化指标的选择策略。方法 回顾性复习既往10年组织病理学特点为小圆细胞的鼻颅底恶性肿瘤122例，比较组织学特征和免疫组化结果。结果 122例患者组织学上是分化差的小圆细胞，全部经免疫组化检测明确诊断，多数患者都在检测5～6个标记物后作出诊断，个别甚至检测20多个标记物才确诊。其中恶性淋巴瘤 43 例，嗅神经母细胞瘤 15 例，原始神经外胚叶恶性肿瘤10例，胚胎性横纹肌肉瘤7例，浆细胞瘤4例，间叶性软骨肉瘤3例，尤文氏(Ewing)肉瘤2例，恶性黑色素瘤 2例，肝细胞癌颅底转移 2 例。结论 本组患者病理组织学特征可确定病变为小圆细胞恶性肿瘤，但难以单凭此作出具体诊断；根据患者的临床特点和病理组织学特征作出可能的诊断考虑，并据此选择合适的免疫组化指标进行检测，可有效地减少诊断延误，使患者得到及时和准确的治疗。
【关键词】小圆细胞性肿瘤；鼻颅底；诊断
Investigation of choosing immunohistochemical marks of small round cell tumor of nasal sinus and bases of skull during diagnosis
, http://www.100md.com
LEI Wen-bin,DONG Yu，JIANG Jie,et al.Department of Pathology,Guangzhou,Guangdong Province 510080,China
【Abstract】 Objective To investigate the features and an accurate pathological diagnosis way of small round cell tumor of nasal sinus and bases of skull.Methods 122 cases of nasal sinus or bases of skull small round cell tumors of our hospital in the past ten years were analyzed retrospectively.Histological and immunohistochemical characters of these cases were compared.Results A lot of small round cells were found in these tumors in histological pathology.At less 5-6 cells,tissue or tumor markers were examined immunohistochemically in most of these cases before the final diagnosis were made.In some cases over 20 markers were examined.M alignant lymphoma was in 43 cases,poorly differentiate squamous carcinoma was in 35 cases,olfactory neuroblastoma was in 15 cases,peripheral primitive neuroectodermal tumor (PNET) was in 10 cases，embryonal rhabdomyosarcoma was in 7 cases,plasmacytoma was in 4 cases,ewing sarcoma was in 2 cases,chondrosarcoma was in 3 cases,chromoma was in 2 cases,nasal sinus or bases of skull found hepatoma metastasis was in 2 cases.Conclusion Histological examination could make certain that the pathological changes were small round cell tumors,but final diagnosis was still hard to make by these,clinical and pathological features could tell the possible diagnosis.Immunohistochemical examination of various markers choosed basing on the possible diagnosis the could not only tell the specimen’s tissue origin characters,but also avoid dally over the diagnosis，it was one of the key for final diagnosis.And then,the patients would get appropriate treatments in time.
, 百拇医药
【Key words】
Small round cell tumor；Nasal sinus and bases of skull；Diagnosis
鼻颅底恶性肿瘤由于分化低，失去原有的组织形态特点，给临床及病理诊断带来困难，免疫组化检测是确诊的主要手段，但由于组织标记物指标众多，如何合理选择指标，将直接影响能否迅速准确诊断，本文将回顾性分析本院收治的鼻颅底小圆细胞恶性肿瘤的特征，探讨其诊断中组织标记物指标选择的策略。
1 材料与方法
1.1 一般资料 回顾性分析我院1996～2006年10年间病理学特点为小圆细胞肿瘤的鼻颅底恶性肿瘤122例。
1.2 方法
1.2.1 病理组织学和免疫组化检测 病理组织学和免疫组化检测结果(包括图片)来自本院病理科，全部诊断均由本院多位病理科医生阅片讨论后作出，病理诊断明确。石蜡切片厚度4 μm，采用链霉菌抗生物素蛋白过氧化物酶连接法( SP法)，不同抗体采取其相应的抗原修复方法。免疫组化所用抗体包括：CK、LCA、L26、UCHL-1，CD3，CD30，CD56、CD79、NSE、Syn、GFAP、CgA，PAS、Vimentin、HHF35、肌红蛋白、Myoglobin、HMB45、S-100、Hepatocyte和AFP均为1∶80。生物素化羊抗鼠IgG，羊抗兔IgG，SP试剂，各项指标均设阳性和阴性对照。
2 结果
鼻颅底小圆细胞肿瘤组织学和免疫组化特点如下:
①恶性淋巴瘤(43例;其中B细胞性的21例，T细胞性的16例，NK细胞性的6例),其组织学特点为B细胞性淋巴瘤中，瘤细胞中等偏小，核不规则，似裂细胞。NK/T细胞淋巴瘤，瘤细胞以大细胞、高度恶性为主，有的瘤细胞浸润血管壁。免疫组化表型检测特点为LCA表达阳性38例，L26阳性18例，UCHL-1阳性14例，CD56阳性6例，CD3阳性5例，CD79阳性4例，CD30阳性4例;, 百拇医药(雷文斌 董 俞 姜 捷 苏振忠 文卫平 史剑波 廖 冰 林汉)
【关键词】小圆细胞性肿瘤；鼻颅底；诊断
Investigation of choosing immunohistochemical marks of small round cell tumor of nasal sinus and bases of skull during diagnosis
, http://www.100md.com
LEI Wen-bin,DONG Yu，JIANG Jie,et al.Department of Pathology,Guangzhou,Guangdong Province 510080,China
【Abstract】 Objective To investigate the features and an accurate pathological diagnosis way of small round cell tumor of nasal sinus and bases of skull.Methods 122 cases of nasal sinus or bases of skull small round cell tumors of our hospital in the past ten years were analyzed retrospectively.Histological and immunohistochemical characters of these cases were compared.Results A lot of small round cells were found in these tumors in histological pathology.At less 5-6 cells,tissue or tumor markers were examined immunohistochemically in most of these cases before the final diagnosis were made.In some cases over 20 markers were examined.M alignant lymphoma was in 43 cases,poorly differentiate squamous carcinoma was in 35 cases,olfactory neuroblastoma was in 15 cases,peripheral primitive neuroectodermal tumor (PNET) was in 10 cases，embryonal rhabdomyosarcoma was in 7 cases,plasmacytoma was in 4 cases,ewing sarcoma was in 2 cases,chondrosarcoma was in 3 cases,chromoma was in 2 cases,nasal sinus or bases of skull found hepatoma metastasis was in 2 cases.Conclusion Histological examination could make certain that the pathological changes were small round cell tumors,but final diagnosis was still hard to make by these,clinical and pathological features could tell the possible diagnosis.Immunohistochemical examination of various markers choosed basing on the possible diagnosis the could not only tell the specimen’s tissue origin characters,but also avoid dally over the diagnosis，it was one of the key for final diagnosis.And then,the patients would get appropriate treatments in time.
, 百拇医药
【Key words】
Small round cell tumor；Nasal sinus and bases of skull；Diagnosis
鼻颅底恶性肿瘤由于分化低，失去原有的组织形态特点，给临床及病理诊断带来困难，免疫组化检测是确诊的主要手段，但由于组织标记物指标众多，如何合理选择指标，将直接影响能否迅速准确诊断，本文将回顾性分析本院收治的鼻颅底小圆细胞恶性肿瘤的特征，探讨其诊断中组织标记物指标选择的策略。
1 材料与方法
1.1 一般资料 回顾性分析我院1996～2006年10年间病理学特点为小圆细胞肿瘤的鼻颅底恶性肿瘤122例。
1.2 方法
1.2.1 病理组织学和免疫组化检测 病理组织学和免疫组化检测结果(包括图片)来自本院病理科，全部诊断均由本院多位病理科医生阅片讨论后作出，病理诊断明确。石蜡切片厚度4 μm，采用链霉菌抗生物素蛋白过氧化物酶连接法( SP法)，不同抗体采取其相应的抗原修复方法。免疫组化所用抗体包括：CK、LCA、L26、UCHL-1，CD3，CD30，CD56、CD79、NSE、Syn、GFAP、CgA，PAS、Vimentin、HHF35、肌红蛋白、Myoglobin、HMB45、S-100、Hepatocyte和AFP均为1∶80。生物素化羊抗鼠IgG，羊抗兔IgG，SP试剂，各项指标均设阳性和阴性对照。
2 结果
鼻颅底小圆细胞肿瘤组织学和免疫组化特点如下:
①恶性淋巴瘤(43例;其中B细胞性的21例，T细胞性的16例，NK细胞性的6例),其组织学特点为B细胞性淋巴瘤中，瘤细胞中等偏小，核不规则，似裂细胞。NK/T细胞淋巴瘤，瘤细胞以大细胞、高度恶性为主，有的瘤细胞浸润血管壁。免疫组化表型检测特点为LCA表达阳性38例，L26阳性18例，UCHL-1阳性14例，CD56阳性6例，CD3阳性5例，CD79阳性4例，CD30阳性4例;, 百拇医药(雷文斌 董 俞 姜 捷 苏振忠 文卫平 史剑波 廖 冰 林汉)