肾上腺髓质分泌物CgA、NSE和SYN在髓质病变中分布特点研究

目的:研究肾上腺髓质分泌物嗜铬蛋白A、神经特异性烯醇化酶和突触素在肾上腺髓质病变中的分布特点;证明肾上腺的内分泌功能是一有机整体,在肾上腺髓质发生病变时,髓质可能参与皮质功能的调节,从而导致皮质功能的异常;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髓质增生、嗜铬细胞瘤和嗜铬细胞癌病例进行嗜铬蛋白A、神经特异性烯醇化酶和突触素染色,正常肾上腺作为对照,观察其在皮质中分布特点。结果:肾上腺嗜铬细胞瘤和嗜铬细胞癌的皮质中均可见嗜铬蛋白A染色阳性细胞,髓质增生和正常肾上腺病例皮质肾上腺髓质分泌物嗜铬蛋白A染色阴性;肾上腺髓质增生和嗜铬细胞癌皮质神经特异性烯醇化酶染色呈阳性,嗜铬细胞瘤和正常肾上腺皮质神经特异性烯醇化酶染色呈阴性;肾上腺髓质增生、嗜铬细胞瘤和嗜铬细胞癌的皮质中神经特异性烯醇化酶染色呈阳性,正常肾上腺皮质神经特异性烯醇化酶染色呈阴性。结论:肾上腺髓质分泌物嗜铬蛋白A、神经特异性烯醇化酶和突触素分布特点可以帮助鉴别肾上腺髓质增生、嗜铬细胞瘤和嗜铬细胞癌。肾上腺皮、髓质之间联系紧密,受共同机理所调控,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。

Application of immunohistochemistry in adrenal medullary neoplasm and hyperplasia

Objective To study the characteristics of chromogranin,synaptophysin and neuron-specific enolase in cortex of adrenal.Methods Immunohistochemical technique was applied to detect the expression of chromogranin,synaptophysin and neuron-specific enolase in routinely processed tissue specimens from human adrenal medullary neoplasm and hyperplasia.Results The chromogranin immunoreactivity was regularly seen in cortex of adrenal neoplasm,but not in the hyperplasia and normal adrenal.The immunoreactive materials appeared in the cytoplasm and in the form of vacuole or grains.Adrenal pheochromocyte carcinoma showed neuron-specific enolase positive cells in cortex,but not in the pheochromocytoma and normal adrenal.The synaptophysin positive materials were showed in medull neoplasm,but not in the normal adrenal.Conclusion The characteristics of chromogranin,synaptophysin and neuron-specific enolase in cortical of adrenal help to make differential diagnosis.Adrenal cortex is closed connective with medulla.Besides classical hypothalamus-pituitary-adrenal axis and rennin-angiotensin-aldosterone system,action of adrenal cortex and medulla has the basis of anatomy and endocrinology.