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目的:分析不同免疫学标志在胰腺实性假乳头肿瘤(solid-pseudopapillary neoplasm,SPN)中的诊断及鉴别诊断价值,以筛选有确诊意义的免疫标志物。方法:分别制作55例SPN、51例胰腺神经内分泌肿瘤(pancreaticneuroendocrine tumor,P-NET)和54例胰腺腺癌(pancreatic adenocarcinoma,PAC)的组织芯片,另收集19例SPN、6例胰腺腺泡细胞癌(acinar cell carcinoma,ACC)、1例胰母细胞瘤(pancreatoblastoma,PB)的手术标本,用免疫组织化学法检测CD99、E-cadherin、β-catenin、P120及其他普遍用于SPN辅助诊断的免疫学标志物在以上各类肿瘤中的表达情况。结果:CD99在所有SPN肿瘤细胞中均显示出独特的核旁点状着色,40例P-NET则显示CD99细胞膜或细胞质及膜阳性着色,4例PAC及1例PB表现出CD99弱膜阳性,而所有ACC细胞均无CD99表达。所有SPN细胞均不表达E-cadherin,β-catenin呈细胞核和细胞质强阳性染色,46例P-NET、52例PAC、6例ACC、1例PB的肿瘤细胞存在E-cadherin膜表达;所有51例P-NET、54例PAC、6例ACC、1例PB肿瘤细胞均有β-catenin膜表达。59例SPN细胞质出现P120着色,6例细胞膜出现P120着色;38例P-NET的细胞质中有P120表达,8例细胞膜上有P120表达;PAC、ACC、PB中分别有48例、5例、1例肿瘤细胞细胞膜表达P120,但未见细胞质中有其表达。其他标志物中,71例SPN、19例P-NET、4例PAC表达PR;59例SPN、46例P-NET、5例PAC表达CD10;66例SPN、45例P-NET、2例PAC表达CD56;72例SPN、48例P-NET、3例PAC表达NSE;ACC及PB对以上各项标志物均呈阴性。结论 :CD99的核旁点状着色是诊断SPN最可靠的免疫学标志,β-catenin和E-cadherin在SPN的诊断及鉴别诊断中也有重要意义。
OBJECTIVE: To analyze the diagnostic and differential diagnostic value of different immunological markers in solid-pseudopapillary neoplasm (SPN) for the screening of diagnostic markers. Methods: Tissue microarrays of 55 cases of SPN, 51 cases of pancreatic neuroendocrine tumor (P-NET) and 54 cases of pancreatic adenocarcinoma (PAC) were made and 19 cases of SPN and 6 cases of pancreatic acinar cells The specimens of acinar cell carcinoma (ACC) and 1 case of pancreatoblastoma (PB) were detected by immunohistochemistry. CD99, E-cadherin, β-catenin and P120 were detected by immunohistochemistry Immunological markers in the above types of tumors in the expression. Results: CD99 showed a unique nucleus punctate staining in all SPN tumor cells, 40 cases of P-NET showed positive staining of CD99 cell membrane or cytoplasm and membrane, 4 cases of PAC and 1 case of PB showed CD99 weak membrane positive, No ACC cells expressed CD99. E-cadherin was not expressed in all the SPN cells. The positive staining of β-catenin in the nuclei and cytoplasm was positive. The expression of E-cadherin was detected in 46 P-NET, 52 PAC, 6 ACC and 1 PB. P-NET cases, 54 cases of PAC, 6 cases of ACC, 1 cases of PB tumor cells have β-catenin membrane expression. There were P120 staining in 59 cases of SPN cytoplasm, P120 staining in 6 cases of cell membrane, P120 expression in cytoplasm of 38 cases of P-NET and P120 expression in 8 cases of cytoplasm. There were 48 cases in PAC, ACC and PB Cases of tumor cell membrane expression P120, but no expression in the cytoplasm. Among the other markers, 71 were SPN, 19 were P-NET, 4 were PAC, 59 were SPN, 46 were P-NET, 5 were CD10, 66 were SPN, 45 were P-NET, The expression of CD56; 72 cases of SPN, 48 cases of P-NET, 3 cases of PAC expression of NSE; ACC and PB of the above markers were negative. Conclusions: Nucleus punctate staining of CD99 is the most reliable immunological marker for diagnosis of SPN. Β-catenin and E-cadherin are also important in the diagnosis and differential diagnosis of SPN.