Jorda Merce, De Madeiros Bruno, Nadji Mehrdad
Department of Pathology, University of Miami/Jackson Memorial Medical Center, Florida 33136, USA.
Appl Immunohistochem Mol Morphol. 2002 Mar;10(1):67-70. doi: 10.1097/00129039-200203000-00012.
Most adrenocortical neoplasms and pheochromocytomas can be diagnosed by a combination of clinical findings and morphologic features. Occasionally, however, this histologic differential diagnosis requires ancillary tests, such as immunohistochemistry. Both tumors are generally negative for epithelial markers but express synaptophysin. Inhibin and chromogranin are used for the diagnosis of adrenocortical neoplasms and pheochromocytomas, respectively. Both antigens, however, are expressed focally and may be completely negative, particularly in small biopsies. The authors investigated the potential value of adding calretinin to inhibin in the differential diagnosis of these tumors. Fifty-five primary adrenal neoplasms including 33 adrenocortical tumors (21 adenomas and 12 carcinomas), 22 pheochromocytomas, and 7 healthy adrenal glands were examined immunohistochemically for the expression of calretinin and inhibin. Inhibin was demonstrated in 24 (73%) adrenocortical neoplasms. When calretinin was added, the number of tumors staining positively for the two markers alone or in combination increased to 31 (94%). Both antigens showed a focal pattern of distribution in many cases. None of the pheochromocytomas reacted for any of these two markers. Healthy adrenal gland showed a distinct positive and negative pattern of immunoreactivity for both antigens in cortex and medulla, respectively. There were no differences between staining patterns of calretinin and inhibin in healthy adrenal cortex, adrenocortical adenomas, and adrenocortical carcinomas. The authors conclude that the addition of calretinin to inhibin increases the sensitivity of the diagnosis of adrenocortical neoplasms. When used together, they are highly specific and sensitive for the differential diagnosis of these tumors from pheochromocytomas. These markers, however, do not distinguish between benign and malignant adrenocortical neoplasms.
大多数肾上腺皮质肿瘤和嗜铬细胞瘤可通过临床发现和形态学特征相结合来诊断。然而，偶尔这种组织学鉴别诊断需要辅助检查，如免疫组织化学。这两种肿瘤通常上皮标志物为阴性，但表达突触素。抑制素和嗜铬粒蛋白分别用于肾上腺皮质肿瘤和嗜铬细胞瘤的诊断。然而，这两种抗原均呈局灶性表达，可能完全阴性，尤其是在小活检标本中。作者研究了在这些肿瘤的鉴别诊断中，将钙视网膜蛋白添加到抑制素检测中的潜在价值。对55例原发性肾上腺肿瘤进行免疫组织化学检查，包括33例肾上腺皮质肿瘤（21例腺瘤和12例癌）、22例嗜铬细胞瘤和7个正常肾上腺，检测钙视网膜蛋白和抑制素的表达。24例（73%）肾上腺皮质肿瘤中检测到抑制素。当添加钙视网膜蛋白后，单独或联合两种标志物染色阳性的肿瘤数量增加到31例（94%）。在许多病例中，这两种抗原均呈局灶性分布模式。嗜铬细胞瘤对这两种标志物均无反应。正常肾上腺在皮质和髓质中分别对这两种抗原呈现明显的阳性和阴性免疫反应模式。钙视网膜蛋白和抑制素在正常肾上腺皮质、肾上腺皮质腺瘤和肾上腺皮质癌中的染色模式无差异。作者得出结论，在抑制素检测中添加钙视网膜蛋白可提高肾上腺皮质肿瘤诊断的敏感性。两者联合使用时，对这些肿瘤与嗜铬细胞瘤的鉴别诊断具有高度特异性和敏感性。然而，这些标志物不能区分肾上腺皮质良性和恶性肿瘤。
