鼻颅底小圆细胞恶性肿瘤诊断中免疫组化指标的选择

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。

Investigation of choosing immunohistochemical marks of small round cell tumor of nasal sinus and bases of skull during diagnosis

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.Malignant 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.