免疫组织化学标记在子宫内膜间质肉瘤诊断和治疗中的价值

 目的 探讨免疫组织化学标记在子宫内膜间质肉瘤（ESS）中的表达及其在诊断和治疗中的价值。方法 用免疫组织化学EnVision二步法对15例原发及3例转移复发ESS进行CD10、SM-MHC、h-caldesmon、AE1／3、CD99、Ki-67、CD34、c-kit、ER、PR的检测，并与其病理组织形态、临床并发症、鉴别诊断及预后对照。结果 17例CD10阳性，其中13例强阳性，7例伴平滑肌分化，3例伴上皮样分化，7例伴性索样分化；ER13例阳性，PR16例阳性； Ki-67 36 %～78 %。结论 子宫内膜间质肿瘤可伴多方向分化，主要为平滑肌和性索样分化；CD10是诊断子宫间质肿瘤的特异抗体，结合组织形态及SM-MHC、h-caldesmon等标记可增加其特异性；ER、PR常规检测主要用于指导孕激素辅助治疗。     

SMA、Desmin、CD10和Vimentin在特殊类型子宫肿瘤诊断中的应用

[目的]探讨SMA、Desmin、CD10和Vimentin在特殊类型子宫肿瘤诊断中的应用价值。[方法]收集特殊类型子宫肿瘤76例（子宫内膜间质肉瘤20例,癌肉瘤17例,平滑肌肉瘤10例,非典型平滑肌瘤16例,上皮样平滑肌瘤13例）,免疫组化SP法检测各组织中平滑肌肌动蛋白（SMA）、结蛋白（Desmin）、CD10和波形蛋白（Vimentin）的表达。[结果]CD10与Vimentin在子宫内膜间质肉瘤和癌肉瘤中高表达,SMA和Desmin在非典型平滑肌瘤和上皮样平滑肌瘤中高表达,Vimentin在平滑肌肉瘤中高表达。[结论]SMA、Desmin、CD10和Vi-mentin在特殊类型子宫肿瘤的诊断中有重要意义。     

钙调蛋白结合蛋白在子宫平滑肌肿瘤诊断中的意义

目的　探讨高度敏感和特异的诊断子宫平滑肌肿瘤的指标。方法　选取子宫内膜间质肉瘤 2 6例 ,子宫普通型和富于细胞性平滑肌瘤各 2 5例 ,子宫平滑肌肉瘤 17例 ,正常子宫肌层和正常子宫内膜各 2 5例 ,采用免疫组化 S-P法检测各种组织中结蛋白、平滑肌肌动蛋白、雌激素受体以及重型钙调蛋白结合蛋白 (h-caldesmon)的表达。结果　正常的子宫肌层、子宫普通型平滑肌瘤、富于细胞性平滑肌瘤和子宫平滑肌肉瘤中重型钙调蛋白结合蛋白的表达分别为 10 0 .0 %、10 0 .0 %、96.0 %和 64.7% ,但正常子宫内膜和子宫内膜间质肉瘤细胞中均未见其表达。重型钙调蛋白结合蛋白诊断富于细胞性平滑肌瘤不仅敏感度高于结蛋白 ,而且特异度达 10 0 .0 %。结论　重型钙调蛋白结合蛋白可辅助正确鉴别子宫富于细胞性平滑肌瘤和子宫内膜间质肉瘤     

病理组织形态学及免疫组化在子宫内膜间质肉瘤诊断中的应用价值

目的探讨病理组织形态学及免疫组化在子宫内膜间质肉瘤诊断中的应用价值。方法选取10例子宫内膜间质肉瘤(ESS)患者和10例子宫高度富于细胞平滑肌瘤(HCL)患者作为观察对象,使用高倍显微镜和免疫组化法进行观察,并将2组患者之间的观察结果进行对比分析。结果 10例子宫内膜间质瘤患者中,有8例为低度恶性子宫内膜间质肉瘤(LGESS),2例为高度恶性子宫内膜间质肉瘤(HGESS)。在8例LGESS中有3例肿瘤为息肉状且进入宫腔,5例肿瘤为基层中或浆膜下独立结节,且呈膨胀性发展,与周围组织的界限模糊,肿瘤直径为3~7 cm,质地细腻,多呈灰黄、灰白色,无出血性倾向,核分裂像为1~4个/10HPF,其中有1例伴随子宫平滑肌瘤。在2例HGESS中,1例呈息肉状进入宫腔,另1例与LGESS相似,切面为灰黄色,切片细腻且伴随大量出血坏死,核分裂像>9个/10HPF。HCL的直径为2.5~10 cm,实性且肿瘤组织呈灰白色,质地不细腻也不粗糙,中等水平。免疫组化SP法检测发现,ESS肿瘤细胞CD10、SMA、MSA以及Desmin的阳性率分别为100.0%、30.0%、30.0%和20.0%,而HCL肿瘤细胞CD10、SMA、MSA以及Desmin的阳性率分别为30.0%、100.0%、100.0%和100.0%,2组间各抗体表达差异均有统计学意义(P<0.05)。结论子宫内膜间质肉瘤患者具有特殊的组织形态学特点,可向平滑肌分化。CD10、SMA、MSA以及Desmin的联合检测是诊断和鉴别ESS与HCL的有效方法,有助于提高临床诊断的准确率。     

CD10鉴别诊断子宫内膜间质肉瘤的系统评价

目的:探讨CD10鉴别诊断不同恶性程度子宫内膜间质肉瘤(endometrial stromal sarcoma,ESS)的临床价值。方法:计算机检索CBM、万方、维普及CNKI数据库,检索年限均从1998年1月到2011年2月。按Cochrane系统评价方法筛选研究、评价纳入研究的方法学质量、提取资料、分析数据。结果:最终16篇文献符合纳入标准,包括330例子宫内膜间质肉瘤患者,其中低度恶性子宫内膜间质肉瘤(low-grade endometrialstromal sarcoma,LGESS)患者301例,高度恶性子宫内膜间质肉瘤(high-grade endometrial stromal sarcoma,HGESS)患者29例。Meta分析结果表明,ESS患者中位CD10表达阳性高达83.2%,CD10表达阳性患者例数明显多于表达阴性者(OR=11.60,95%CI=7.80-17.26,P<0.001);LGESS和HGESS患者中位CD10表达阳性率分别为93.5%和58.6%,LGESS患者CD10表达阳性率显著高于HGESS患者(OR=3.05,95%CI=1.79-5.24,P=0.040)。结论:CD10表达水平与ESS恶性程度密切相关,LGESS患者CD10表达水平高于HGESS者,故CD10对于鉴别诊断不同恶性程度ESS具有重要临床价值。     

卵巢子宫内膜样间质肉瘤临床病理观察

目的探讨卵巢子宫内膜样间质肉瘤的发生机制、临床病理特征、诊断与鉴别诊断及预后。方法 对1例卵巢子宫内膜样间质肉瘤进行光镜、免疫组化检测, 并复习有关文献。结果 肿瘤组织由形似增生期子宫内膜间质细胞的小细胞组成, 瘤细胞呈卵圆形或短梭形, 胞浆稀少, 肿瘤细胞呈漩涡状围绕似子宫内膜螺旋小动脉的厚壁小血管。免疫组化示瘤细胞表达Vimentin和CD10, 不表达Calretinin, α-inhibin, H-caldesmon, CD99, CD117, CD34, desmin, SMA and CK(AE1/AE3)。结论 卵巢子宫内膜样间质肉瘤在临床为一惰性生长的恶性肿瘤, 非常罕见。其鉴别诊断主要包括子宫内膜间质肉瘤累及卵巢(直接侵犯或转移)和卵泡膜细胞-纤维瘤。     

96例胃肠道间质瘤临床诊治分析

目的　探讨胃肠道间质瘤的病理诊断、外科治疗及预后相关因素。方法　回顾分析 96例经手术治疗的胃肠道间质瘤患者的临床病理资料 ;免疫组织化学方法检测CD117、CD34、平滑肌肌动蛋白 (SMA)和S 10 0的表达情况。结果　免疫组织化学阳性表达率CD117为 79.2 % (76 / 96 )、CD34为 5 8.3% (5 6 / 96 )、SMA为 35 .4 % (34/ 96 )、S 10 0为 9.4 % (9/ 96 )。良性 2 3例 ,恶性 73例。恶性组病例中 ,首次手术中切除大网膜 39例 ,未切除大网膜 34例 ,转移复发率分别为 5 .1%和 2 6 .5 % (P <0 .0 5 ) ;手术切除肠管断端距肿瘤 >5cm 4 6例 ,≤ 5cm 2 7例 ,转移复发率分别为 6 .5 %和 2 9.6 % (P <0 .0 5 )。良、恶性胃肠道间质瘤 5年生存率分别为 91.5 %和 5 7.3%。结论　CD117及CD34等免疫标记物配合使用可以提高胃肠道间质瘤的病理诊断准确率。采用合理的首次手术治疗及大网膜预防性切除可减少胃肠道间质瘤的复发。     

CD117在胃肠道间质瘤中的表达及意义

目的探讨CD117在胃肠道间质瘤中的表达及其意义。方法应用免疫组织化学方法检测100例胃肠道间质瘤组织CD117的表达。结果 100例胃肠道间质瘤组织中,CD117阳性表达率为96.0%（96/100）,其中胃阳性率为96.9%（63/65）,小肠阳性率为96.4%（27/28）,腹膜后阳性率为85.7%（6/7）;良性间质瘤阳性率为96.4%（80/83）,交界性阳性率为91.7%（11/12）,恶性阳性率为100.0%（5/5）,CD117表达在不同部位间及不同生物学行为间差异均无统计学意义（P〉0.05）。结论 CD117是诊断胃肠道间质瘤特异性较高的抗体,在与胃肠道平滑肌肿瘤、雪旺氏肿瘤的鉴别诊断上也具有较高的价值;CD117的表达与间质瘤分布部位及良、恶性无关,不能作为分化程度的指标。     

胃肠道间质瘤19例临床病理分析

目的:探讨胃肠道间质瘤(gastrointestinalstromaltumors,GIST)的临床病理、免疫组化特征、鉴别诊断和治疗方法。方法:应用光镜观察形态特征,应用免疫组化SP法对胃肠道和胃肠外腹腔内原诊断为平滑肌瘤、平滑肌母细胞瘤和平滑肌肉瘤24例检测CD117、CD34、Vimentin、SMA和S100,获得19例GIST。结果:19例GIST占同期消化系统间叶肿瘤的79.2%(19/24)。抗体表达情况:CD11794.7%(18/19)、CD3463.2%(12/19)、Vimentin100%(19/19)、SMA15.8%(3/19)阳性和S100表达全部阴性。结论:GIST是消化道最常见的间叶性肿瘤。CD117、CD34、SMA和S100联合使用可协助鉴别诊断GIST。细胞密集、明显核异形、肿瘤性坏死以及核分裂数>5/50HP可作为恶性参考指标,手术切除是主要的治疗方式。     

低级别子宫内膜间质肉瘤的临床诊治探讨

为了探讨低级别子宫内膜间质肉瘤(LESS)的临床病理学特征、诊断和鉴别诊断,分析10例LESS的临床病理特点、网织纤维染色和免疫组化染色研究其病理学特征。结果显示,LESS临床上主要表现为阴道不规则流血;瘤细胞类似于增生期子宫内膜间质细胞,形态较一致,圆形或卵圆形,少数为短梭形,胞质较少,胞核圆形或不规则形,核染色质较细;肿瘤内有大量丛状生长的分支状小的、薄壁的血管,类似于子宫内膜的螺旋动脉,部分肿瘤血管透明变性呈星状或放射状结构;网织纤维染色见网状纤维丰富,围绕瘤细胞生长。肿瘤细胞8例CD10阳性,6例ER阳性,6例PR阳性,2例Actin阳性,CD34、CD117和Melan-A肿瘤细胞均阴性。初步研究结果提示,LESS易误诊为子宫内膜间质结节、未分化子宫内膜间质肉瘤、富于细胞性平滑肌瘤、静脉内平滑肌瘤病及血管周上皮样细胞肿瘤,确诊主要依靠组织病理学和免疫组织化学。     

Cyclooxygenase-2 expression in malignant mesenchymal tumors and related uterine lesions

The aim of this study was to determine whether the expression of cyclooxygenase-2 (COX-2) in uterine sarcoma cells and carcinosarcoma cells is associated with cell type. Nineteen sections of tissues from uterine sarcomas, carcinosarcomas, and an adenosarcoma, and endometrial stromal sarcomas, were immunohistochemically analyzed for the cellular expression of COX-2. Positive immunostaining for COX-2 was observed in 88.9% (8/9) uterine carcinosarcomas, uterine adenosarcomas but was not observed in uterine sarcomas and the endometrial stromal sarcoma (0/10). But positive immunostaining for COX-2 was observed in some sarcomatoid cells in carcinosarcoma tissue. These findings suggest that some of the sarcoma cells in uterine carcinosarcomas resemble epithelial malignant cells in regard to the increase in COX-2 expression, and support the hypothesis that some uterine carcinosarcomas are combination tumors. This may serve as a basis for new chemoprevention and treatment strategies for uterine carcinosarcomas through the inhibition of COX-2 activity.     

Hormonal therapy in gynecological sarcomas

Gynecological sarcomas are rare, constituting 3-5% of uterine malignancies. Endometrial stromal sarcomas and some uterine leiomyosarcomas are characterized by estrogen receptor (ER) and progesterone receptor (PgR) expression with variable impact on their clinical behavior and potential response to systemic therapies. A variety of hormonal treatments have been tested, since they act as targeted treatment against ER and PgR and have a tolerable side effect profile, which allows them to be administered for prolonged periods. Their role has been studied more extensively in endometrial stromal sarcomas, as the majority of cases are ER/PgR positive, while recently, an emerging role for hormonal manipulation has been described in ER/PgR-positive uterine leiomyosarcomas. Owing to the rarity and heterogeneous nature of uterine sarcomas, current treatment recommendations are based on small retrospective studies and case reports. This review comprises a critical appraisal of the existing data regarding hormonal manipulation in uterine sarcomas and attempts to make recommendations for endocrine treatments in specific settings, as well as suggest targets/medications for future research.     

91例胃肠道间质瘤的临床病理特征分析

目的探讨胃肠道间质瘤的临床病理学特征。方法收集2010年1月至2013年12月间91例经病理诊断的胃肠道间质瘤,对其临床病理资料进行回顾性分析,并对标本进行CD117、CD34、DOG1、Desmin及S-100检测。结果在91例胃肠道间质瘤患者中,有38例患者为恶性,21例为交界性,32例为良性。CD117呈阳性79例,占86.8%;CD34呈阳性69例,占75.8%;DOG1呈阳性74例,占81.3%;SMA呈阳性39例,占42.9%;Desmin呈阳性15例,占16.5%;S-100呈阳性4例,占4.4%。结论胃肠道间质瘤的发生部位多,形态学复杂,诊断还需要联合病理切片和免疫组化检测,CD117、CD34和DOG1三者联合检测可提高胃肠道间质瘤的诊断准确率,而SMA、Desmin及S100是重要的鉴别诊断指标。     

c-Kit expression in patients with uterine leiomyosarcomas: a potential alternative therapeutic treatment.

PURPOSE: Uterine leiomyosarcomas are rare tumors characterized by their resistance to chemotherapy and radiation treatment. Surgery is the primary method of treatment, but for patients with unresectable disease, alternate therapeutic options are clearly warranted. According to initial observations of c-KIT expression, correlation with a bad prognosis, and the successful therapeutic possibility of STI571 in gastrointestinal stromal tumors, the data have encouraged us to study c-KIT expression in these tumors. EXPERIMENTAL DESIGN: We analyzed the expression of c-KIT and genetic assessment of exon 11 of c-kit gene in 32 uterine leiomyosarcomas. RESULTS: In 17 cases (53.1%), we observed a c-KIT expression in tumor cells. Of the 17 patients with distinct c-KIT-positive immunoreactivity, eight had I or II stage disease and nine had III or IV stage disease. Molecular genetic analysis of exon 11, analyzed by direct DNA sequencing, was performed for all of the c-KIT-positive uterine leiomyosarcomas. No mutations were found. CONCLUSION: The conventional chemotherapy in leiomyosarcomas appears to be ineffective for patients with metastatic or unresectable disease, and the management of these patients poses a special problem. In these women, new therapeutic strategies are warranted. The treatment with STI571 in leiomyosarcoma patients might be hypothesized, because uterine leiomyosarcomas also express c-KIT.     

与胃间质瘤恶性程度相关的临床病理和免疫组化研究

目的：探讨胃间质瘤的临床表现，病理组织形态学和免疫组织化学特点及恶性程度指标。方法：用CD117、CD34、SMA、S-100、ki67五种抗体，通过免疫组织化学SABC法，确诊99例胃间质瘤，并结合临床、病理及随访资料，对其生物学行为进行分析。结果：本组胃间质瘤，CD117和CD34多为弥漫强阳性，阳性率分别为90．9％、74．7％、SMA、S-100呈片状或局灶阳性，阳性率分别为15．2％、5．1％，ki67标记指数为5．1％。潜在恶性52例，恶性47例，平均随访期为5年，各组之间瘤体直径大于5cm，核分裂象大于5／50HPF，差异有显著性意义。单因素分析瘤体大小，恶性程度。核分裂象，完整切除均与生存率有关。多因素分析只有完整切除为决定生存率有意义指标。结论：胃间质瘤免疫组织化学特征为CD117、CD34阳性，瘤体直径大于5cm，核分裂象大于5／50HPF可作为高度恶性参考指标。     

Rapid induction of uterine tumors with p53 point mutations in heterozygous p53-deficient CBA mice given a single intraperitoneal administration of N-ethyl-N-nitrosourea

To investigate the sensitivity of heterozygous p53-deficient CBA mice to carcinogens, 20 female mice [p53(+/-)] and 20 wild-type littermates [p53(+/+)] were given an intraperitoneal injection of 120 mg/kg body wt of N-ethyl-N-nitrosourea (ENU) and were maintained without any other treatment for a further 26 weeks. Histopathology showed that uterine tumors (endometrial polyps and stromal sarcomas) and lung adenomas were induced in both p53(+/-) and p53(+/+) mice. The incidence of uterine tumors and lung adenomas (94% and 81%, respectively) in p53(+/-) mice was significantly greater than that in p53 (+/+) mice (37% and 42%, respectively). Malignant lymphomas were only induced in p53(+/-) mice, at an incidence of 31%. Concerning uterine tumors and preneoplastic lesions, there were endometrial stromal sarcomas and atypical hyperplasias of the endometrial gland in 90% and 63%, respectively, of p53(+/-) mice, with significantly greater incidences than in p53(+/+) mice. Gene analysis revealed GCG-->GTG point mutations in codon 135 of exon 5 of the p53 allele in all of the uterine endometrial stromal sarcomas examined. Our results suggest that female p53(+/-) CBA mice are very susceptible to uterine carcinogenesis, providing a useful model for ENU-induced uterine tumors.     

胃肠道及胃肠道外间质瘤的临床病理及免疫组化分析

目的:研究胃肠道及胃肠道外间质瘤的临床病理及免疫组化特点。方法:应用光学显微镜观察20例胃肠道及胃肠道外间质瘤的形态特征,用免疫组化SP法检测CD117、CD34、Vimentin、SMA、desmin及S-100等6种抗体的表达情况。结果:20例间质瘤中,女性11例,男性9例,平均年龄59·82岁(27~80岁)。发生部位:胃8例(40%),小肠4例(20%),大肠2例(10%),食管1例(5%),肠系膜4例(20%),大网膜1例(5%)。肿瘤镜下主要由梭形和上皮样细胞组成,有栅栏状、交叉束状、漩涡状及巢状等多种排列。CD117、CD34、Vimentin、SMA、desmin及S-100表达阳性率分别为95%(19/20),75%(15/20),100%(20/20),40%(8/20),5%(1/20)及25%(5/20)。临床症状以腹部包块、腹部不适及消化道出血为主。良性3例(3/20),潜在恶性4例(4/20),恶性13例(13/20)。恶性间质瘤中的核分裂>5/50HPF、肿瘤细胞坏死及细胞密集比良性和低度恶性者常见(P<0·05)。结论:间质瘤多发生于老年人,无性别差异,胃肠道是其好发部位,细胞排列多样,具有多向分化能力,免疫组化证实部分GIST具有不完全的平滑肌、神经单向或双向分化特征。核分裂>5/50HPF、肿瘤细胞坏死及细胞密集是重要的恶性指征。CD117及CD34是其较特异及敏感的抗体,免疫组化在间质瘤的诊断及鉴别诊断中起重要作用。     

CD117在胃肠间质瘤中表达的临床病理意义

目的探讨CD117在胃肠间质瘤中表达的临床病理意义。方法应用免疫组化Envision法检测34例GIST中CD117、CD34、a-SMA、S-100、及其中13例GIST中nestin蛋白等的表达情况。结果34例GIST中CD117和CD34阳性率为94.1%、79.4%。a-SMA、S-100阳性率分别为29.4%、35.3%。13例GIST中nestin阳性率100.0%。结论CD117作为GIST的辅助诊断指标具有较高的敏感性,但是CD117表达与GIST的良恶性和组织学类型无关,CD117和CD34联合检测,能辅助诊断大部分GIST,但是尚需探讨nestion等其他指标在GIST中的表达,并积极开展c-kit基因在GIST中突变研究。     

50例子宫内膜间质肿瘤临床病理分析

目的:探讨子宫内膜间质肿瘤的临床、病理及其多成分分化特点、鉴别诊断及预后。方法:分析50例子宫内膜间质肿瘤(子宫内膜间质结节6例、低度恶性子宫内膜间质肉瘤30例、未分化子宫内膜肉瘤11例、子宫内膜间质平滑肌混合瘤3例)的临床、病理、合并症、鉴别诊断及预后。结果:不同类型肿瘤均有部分病例伴多成分分化,(12例伴平滑肌分化、10例伴性索样分化、1例伴纤维分化、1例伴纤维粘液样分化、1例伴上皮样分化,其中10例同时伴两种分化成分)。50例中有9例伴发子宫平滑肌瘤(其中1例同时伴发腺瘤样瘤,1例伴发高分化子宫内膜腺癌)。结论:不同类型子宫内膜间质肿瘤均可伴发多成分分化及其他类型肿瘤,具备多样性病理形态特征,肿瘤有无浸润及肿瘤细胞异型程度、核分裂象数量是确定本瘤性质的必备条件。