Becher Mark W, Abel Ty W, Thompson Reid C, Weaver Kyle D, Davis Larry E
Department of Pathology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-2561, USA.
J Neuropathol Exp Neurol. 2006 Oct;65(10):935-44. doi: 10.1097/01.jnen.0000235124.82805.2b.
Metastatic neoplasms to the central nervous system are often encountered in the practice of surgical neuropathology. It is not uncommon for patients with systemic malignancies to present to medical attention because of symptoms from a brain metastasis and for the tissue samples procured from these lesions to represent the first tissue available to study a malignancy from an unknown primary. In general surgical pathology, the evaluation of a metastatic neoplasm of unknown primary is a very complicated process, requiring knowledge of numerous different tumor types, reagents, and staining patterns. The past few years, however, have seen a remarkable refinement in the immunohistochemical tools at our disposal that now empower neuropathologists to take an active role in defining the relatively limited subset of neoplasms that commonly metastasize to the central nervous system. This information can direct imaging studies to find the primary tumor in a patient with an unknown primary, clarify the likely primary site of origin in patients who have small tumors in multiple sites without an obvious primary lesion, or establish lesions as late metastases of remote malignancies. Furthermore, specific treatments can begin and additional invasive procedures may be prevented if the neuropathologic evaluation of metastatic neoplasms provides information beyond the traditional diagnosis of "metastatic neoplasm." In this review, differential cytokeratins, adjuvant markers, and organ-specific antibodies are described and the immunohistochemical signatures of metastatic neoplasms that are commonly seen by neuropathologists are discussed.
在外科神经病理学实践中，经常会遇到中枢神经系统的转移性肿瘤。患有全身恶性肿瘤的患者因脑转移症状而就医，且从这些病变获取的组织样本成为研究未知原发恶性肿瘤的首个可用组织，这种情况并不罕见。在一般外科病理学中，评估未知原发灶的转移性肿瘤是一个非常复杂的过程，需要了解众多不同的肿瘤类型、试剂和染色模式。然而，在过去几年中，我们所掌握的免疫组化工具取得了显著改进，这使神经病理学家能够在确定通常转移至中枢神经系统的相对有限的肿瘤亚组方面发挥积极作用。这些信息可以指导影像学检查，在原发灶不明的患者中找到原发肿瘤，在多个部位有小肿瘤且无明显原发病变的患者中明确可能的原发部位，或者将病变确定为远处恶性肿瘤的晚期转移灶。此外，如果转移性肿瘤的神经病理学评估能够提供超出“转移性肿瘤”传统诊断的信息，就可以开始进行特定治疗并避免额外的侵入性操作。在这篇综述中，将描述不同的细胞角蛋白、辅助标记物和器官特异性抗体，并讨论神经病理学家常见的转移性肿瘤的免疫组化特征。
