Kommoss F, Oliva E, Bittinger F, Kirkpatrick C J, Amin M B, Bhan A K, Young R H, Scully R E
Department of Pathology, University of Mainz, Germany.
Hum Pathol. 2000 Sep;31(9):1055-61. doi: 10.1053/hupa.2000.16237.
We investigated 115 testicular and 3 epididymal tumors and 6 cases of the complete androgen insensitivity syndrome (AIS) for the expression of inhibin-alpha, CD99, HEA125, PLAP, and chromogranin, using monoclonal antibodies and standard immunhistochemical techniques. Ihibin-alpha was detected in the neoplastic cells in 27 of 27 primary Leydig cell tumors (LCTs), 1 of 1 metastatic LCT, 6 of 20 Sertoli cell tumors (SCTs), 4 of 5 juvenile granulosa cell tumors (GCTs), and 2 of 5 unclassified sex cord-stromal tumors (USCSTs). Except for 2 choriocarcinomas, the choriocarcinomatous component of 1 mixed germ cell tumor, and a small focus of inhibin-positive syncytiotrophoblast in 1 embryonal carcinoma, inhibin-a immunoreactivity was not present in the neoplastic cells of the 38 remaining testicular germ cell tumors; 11 B-cell and 1 T-cell lymphomas; 1 granulocytic sarcoma; and 1 rhabdomyosarcoma of the testis; 1 adenoma of the rete testis, and 3 adenomatoid tumors of the epididymis. Inhibin-alpha immunoreactivity was present in the Sertoli cells and Leydig cells in 5 testicular hamartomas and in 1 Sertoli cell adenoma in 6 cases of AIS; both Sertoli and Leydig cells were also positive in the extranodular testicular parenchyma present in 2 of these cases. CD99 was detected in 10 of 15 primary LCTs, 1 of 7 SCTs, 3 of 5 JGCTs, and in 1 of 5 USCSTs but was not found in any tumor outside the sex cord-stromal category. HEA125 immunostaining was not detected in sex cord-stromal tumors; however, 3 of 12 seminomas, 3 of 12 embryonal carcinomas, 6 of 8 yolk sac tumors, and 1 of 2 teratomas were HEA125 positive. PLAP was not detected in sex cord-stromal tumors except for 4 of 15 primary LCTs but was present in most germ cell tumors. Chromogranin immunostaining was present in the sex cord-like element in 1 of 5 USCSTs, 1 of 8 YSTs, 1 of 2 teratomas, and in 1 of 1 rete adenoma, and in normal adjacent rete testis. In conclusion, although inhibin-alpha and PLAP, and, to a somewhat lesser extent, CD99 and HEA125 immunostaining are helpful in the differential diagnosis of certain testicular neoplasms that are difficult to distinguish on morphologic grounds, chromogranin is far less helpful in this context.
我们使用单克隆抗体和标准免疫组织化学技术，对115例睾丸肿瘤、3例附睾肿瘤以及6例完全性雄激素不敏感综合征（AIS）病例进行了抑制素α、CD99、HEA125、胎盘碱性磷酸酶（PLAP）和嗜铬粒蛋白表达情况的研究。在27例原发性睾丸间质细胞瘤（LCT）中的27例、1例转移性LCT、20例支持细胞瘤（SCT）中的6例、5例幼年型颗粒细胞瘤（GCT）中的4例以及5例未分类性索间质肿瘤（USCST）中的2例的肿瘤细胞中检测到抑制素α。除2例绒毛膜癌、1例混合性生殖细胞肿瘤的绒毛膜癌成分以及1例胚胎癌中一小灶抑制素阳性合体滋养层外，其余38例睾丸生殖细胞肿瘤、11例B细胞和1例T细胞淋巴瘤、1例粒细胞肉瘤、1例睾丸横纹肌肉瘤、1例睾丸网腺瘤以及3例附睾腺瘤样瘤的肿瘤细胞中均未检测到抑制素α免疫反应性。在5例睾丸错构瘤的支持细胞和间质细胞以及6例AIS患者中的1例支持细胞瘤性腺瘤中检测到抑制素α免疫反应性；其中2例患者的睾丸结节外实质中的支持细胞和间质细胞也呈阳性。在15例原发性LCT中的10例、7例SCT中的1例、5例JGCT中的3例以及5例USCST中的1例检测到CD99，但在性索间质肿瘤以外的任何肿瘤中均未发现。在性索间质肿瘤中未检测到HEA125免疫染色；然而，12例精原细胞瘤中的3例、12例胚胎癌中的3例、8例卵黄囊瘤中的6例以及2例畸胎瘤中的1例HEA125呈阳性。除15例原发性LCT中的4例以外，在性索间质肿瘤中未检测到PLAP，但在大多数生殖细胞肿瘤中存在。在5例USCST中的1例、8例YST中的1例、2例畸胎瘤中的1例、1例睾丸网腺瘤以及相邻正常睾丸网中，嗜铬粒蛋白免疫染色存在于性索样成分中。总之，尽管抑制素α和PLAP，以及在一定程度上CD99和HEA125免疫染色有助于某些在形态学上难以区分的睾丸肿瘤的鉴别诊断，但在这种情况下嗜铬粒蛋白的帮助要小得多。
