Puebla-Mora Ana Graciela, Heras Alfonso, Cano-Valdez Ana María, Domínguez-Malagón Hugo
Department of Pathology, Instituto Nacional de Cancerologia, Tlalpan, D.F. 14080, México.
Ann Diagn Pathol. 2006 Aug;10(4):205-8. doi: 10.1016/j.anndiagpath.2005.09.021.
Human telomerase detected by in situ hybridization has been demonstrated to be a useful tool for the diagnosis of malignancy and has also been tested by reverse transcriptase-polymerase chain reaction in several tumors such as hepatic cell carcinoma, melanoma, colonic carcinoma, gastric carcinoma, biliary carcinoma, breast carcinoma, mesothelioma, lung carcinoma, female tract carcinoma, and prostatic carcinoma. A monoclonal antibody (clone Tel-24) that allows for the detection of human telomerase reverse transcriptase (hTERT) in paraffin blocks of archival material has recently been developed. Carcinomas of cervix, endometrium, and breast have been studied by this method, but its value in prostatic carcinoma has not been explored; for that reason, we studied benign and malignant prostatic lesions by immunohistochemistry using paraffin embedded tissue. The aim of the study was to define the sensitivity and specificity of hTERT in prostate cancer, in comparison with alpha-methylacyl-coenzyme A racemase (AMACR) (P504-S). Fifty-five specimens of diverse prostatic lesions were selected for study (43 needle biopsies and 12 transurethral resections); there were 61 malignancies (47 infiltrating carcinomas and 14 high-grade prostatic intraepithelial neoplasias [PIN]) and 29 benign lesions (10 basal cell hyperplasias, 12 nodular hyperplasias, 4 chronic prostatitis, and 3 atrophic glands). Signal for hTERT nucleolar was detected in 31 of 47 infiltrating adenocarcinomas, in 11 of 14 PIN, and in none of 27 benign lesions (sensitivity, 71%; specificity, 100%). Diffuse cytoplasmic positivity for AMACR was found in 37 of 41 infiltrating adenocarcinomas, in 7 of 7 PIN, and in 6 of 22 benign lesions (sensitivity, 91%; specificity, 72%). These results indicate that hTERT is highly specific of malignancy, with no false-positive cases; however, it had lower sensitivity than AMACR.
原位杂交检测的人端粒酶已被证明是诊断恶性肿瘤的一种有用工具，并且也已通过逆转录聚合酶链反应在几种肿瘤中进行了检测，如肝细胞癌、黑色素瘤、结肠癌、胃癌、胆管癌、乳腺癌、间皮瘤、肺癌、女性生殖道癌和前列腺癌。最近开发了一种单克隆抗体（克隆Tel-24），可用于检测存档材料石蜡块中的人端粒酶逆转录酶（hTERT）。已通过这种方法研究了子宫颈癌、子宫内膜癌和乳腺癌，但尚未探讨其在前列腺癌中的价值；因此，我们使用石蜡包埋组织通过免疫组织化学研究了良性和恶性前列腺病变。该研究的目的是与α-甲基酰基辅酶A消旋酶（AMACR）（P504-S）相比，确定hTERT在前列腺癌中的敏感性和特异性。选择了55个不同的前列腺病变标本进行研究（43例针吸活检和12例经尿道切除术）；其中有61例恶性肿瘤（47例浸润性癌和14例高级别前列腺上皮内瘤变[PIN]）和29例良性病变（10例基底细胞增生、12例结节性增生、4例慢性前列腺炎和3例萎缩性腺）。在47例浸润性腺癌中的31例、14例PIN中的11例以及27例良性病变中均未检测到hTERT核仁信号（敏感性为71%；特异性为100%）。在41例浸润性腺癌中的37例、7例PIN中的7例以及22例良性病变中的6例中发现AMACR弥漫性细胞质阳性（敏感性为91%；特异性为72%）。这些结果表明，hTERT对恶性肿瘤具有高度特异性，无假阳性病例；然而，其敏感性低于AMACR。
