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目的通过检测血管内皮生长因子(VEGF)、微血管密度(MVD)在良、恶性嗜铬细胞瘤中的表达情况,探讨VEGF能否成为预判恶性嗜铬细胞瘤的指标,并阐明其与MVD间的关系。方法选取1986年10月-2006年8月住院经手术治疗,且具有完整的临床、病理和随访资料的嗜铬细胞瘤患者存档石蜡标本38例,其中良性嗜铬细胞瘤21例,恶性嗜铬细胞瘤17例。恶性嗜铬细胞瘤组中首次手术确诊为嗜铬细胞瘤后随访4-155个月;良性嗜铬细胞瘤组中首次手术确诊为嗜铬细胞瘤后随访69-240个月。另取20例因良性肾疾患行肾切除时获取的同侧正常肾上腺组织作为对照组。采用免疫组织化学技术,检测良、恶性嗜铬细胞瘤及20例正常肾上腺髓质组织中VEGF的表达情况及CD34标记的MVD表达情况。结果VEGF在恶性嗜铬细胞瘤中呈高表达,阳性率为82.40%,在良性嗜铬细胞瘤和正常肾上腺髓质组织中的阳性率分别为23.80%、5.00%,VEGF在恶性嗜铬细胞瘤中的表达与在良性嗜铬细胞瘤和正常肾上腺髓质组织中的表达有显著性差异(P<0.05),而在良性嗜铬细胞瘤和正常肾上腺髓质组织中的表达没有显著性差异(P>0.05)。MVD在恶性嗜铬细胞瘤中表达最高(36.41±13.00),良性嗜铬细胞瘤中次之(21.43±8.05),正常肾上腺髓质组织中表达最少(13.36±4.34),两两之间比较有显著性差异(P<0.05)。在嗜铬细胞瘤中VEGF的表达与MVD呈正相关。结论VEGF有望成为预判恶性嗜铬细胞瘤的一项指标。VEGF在恶性嗜铬细胞瘤中的表达与MVD呈正相关,提示微血管的形成与VEGF的调控有关,MVD增高是恶性嗜铬细胞瘤发生侵袭和远处转移的基础。
Objective To investigate the expression of vascular endothelial growth factor (VEGF) and microvessel density (MVD) in benign and malignant pheochromocytomas and to explore whether VEGF can be used as a predictor of malignant pheochromocytoma and to clarify its relationship with MVD Relationship. Methods 38 patients with pheochromocytoma were admitted to our hospital from October 1986 to August 2006 with complete clinical, pathological and follow-up data. There were 38 paraffin-embedded specimens of benign pheochromocytoma including 21 malignant chrome 17 cases of cell tumor. Malignant pheochromocytoma group was followed up for 4-155 months after the first surgery was diagnosed as pheochromocytoma; followed by 69-240 months after pheochromocytoma was diagnosed in the benign pheochromocytoma group. Another 20 cases of nephrectomy due to benign renal disease obtained ipsilateral normal adrenal tissue as a control group. Immunohistochemical technique was used to detect the expression of VEGF and the expression of CD34-MVD in benign and malignant pheochromocytoma and 20 cases of normal adrenal medulla. Results VEGF was highly expressed in malignant pheochromocytomas with a positive rate of 82.40%. The positive rates of VEGF in benign pheochromocytoma and normal adrenal medulla were 23.80% and 5.00%, respectively. The positive rates of VEGF in malignant pheochromocytoma (P <0.05), but no significant difference in the expression between benign pheochromocytoma and normal adrenal medulla (P <0.05) P> 0.05). MVD was the highest in malignant pheochromocytoma (36.41 ± 13.00), benign pheochromocytoma (21.43 ± 8.05), and the lowest in normal adrenal medulla (13.36 ± 4.34) Significant difference (P <0.05). The expression of VEGF in pheochromocytoma was positively correlated with MVD. Conclusion VEGF is expected to be a predictor of malignant pheochromocytoma. The expression of VEGF in malignant pheochromocytoma was positively correlated with MVD, suggesting that the formation of microvessel is related to the regulation of VEGF. The increased MVD is the basis of invasion and distant metastasis of malignant pheochromocytoma.