肾上腺髓质分泌物在皮髓质中分布特点的研究

目的研究肾上腺髓质分泌物嗜铬蛋白A(CgA)、神经特异性烯醇化酶(NSE)和突触素(SYN)在皮、髓质中的分布特点,证明肾上腺髓质可能参与皮质功能的调节,阐明出现临床诊断与病理诊断不一致性的可能原因,为进一步深入研究皮髓质之间的相互作用奠定基础。方法运用免疫组化方法对肾上腺肿瘤病例进行CgA、NSE和SYN染色,观察其在皮髓质中分布特点。结果肾上腺皮质腺瘤、皮质腺癌、嗜铬细胞瘤和嗜铬细胞癌的皮质中均可见CgA染色阳性细胞,皮质增生、髓质增生和正常肾上腺病例皮质CgA染色阴性;肾上腺皮质增生、皮质腺瘤、皮质腺癌、髓质增生和嗜铬细胞癌NSE染色呈阳性,嗜铬细胞瘤和正常肾上腺皮质NSE染色呈阴性;皮质增生、皮质腺瘤、髓质增生、嗜铬细胞瘤和嗜铬细胞癌的皮质中SYN染色呈阳性,皮质腺癌和正常肾上腺皮质SYN染色呈阴性;所有病例髓质CgA、NSE和SYN染色均呈强阳性。结论⑴肾上腺皮质CgA、NSE和SYN分布特点可以帮助鉴别肾上腺肿瘤及增生性疾病。⑵肾上腺皮髓质之间联系紧密,受共同机制所调控,除经典的下丘脑-垂体-肾上腺轴和肾素-血管紧张素-醛固酮系统外,肾上腺皮髓质之间存在相互调节的解剖学和内分泌学基础。

Characteristic of chromogranin A, synaptophysin and neuron-specific enolase in cortex and medulla of adrenal

Objective To study the characteristic of chromogranin A(CgA),synaptophysin(SYN) and neuron-specific enolase(NSE) in cortex and medulla of adrenal.Methods Immunohistochemical method was used to detect the expression of CgA,SYN and NSE in routinely processed tissue specimens from human adrenal neoplasm and hyperplasia.Results The expression of CgA was detected in cortex of adrenocortical adenoma,adrenal neoplasm and chromophile tumor,but not in that of hyperplasia and normal adrenal.The expression of NSE was detected in cortex of adrenal cortical hyperplasia,cortical adenomas and pheochromocyte carcinoma,but not in that of pheochromocytoma and normal adrenal.The expression of SYN was detected in cortex of corticohyperplassia,cortical adenomas,medull neoplasm,chromophile tumor and pheochromocyte carcinoma,but not in that of cortical adenocarcinoma and normal adrenal.The expressions of CgA,NSE and SYN were detected in the medulla of all cases.Conclusion The characteristic of CgA,SYN and NSE in cortex and medulla of adrenal are useful in the differential diagnosis of tumor and hyperplasia in the adrenal.The relationship between the adrenal cortex and medulla is close.Besides the classical hypothalamus-pituitary-adrenal axis(HPAA) and rennin-angiotensin-aldosterone system(RAAS),the adrenal cortex and medulla have the basis of anatomy and endocrinology.