Prasad Manju L, Barbacioru Catalin C, Rawal Yeshwant B, Husein Omar, Wen Ping
Department of Pathology, Ohio State University, Columbus, OH, USA.
Mod Pathol. 2008 Feb;21(2):105-14. doi: 10.1038/modpathol.3800983. Epub 2007 Dec 14.
Distinguishing adenoid cystic carcinoma from polymorphous low-grade adenocarcinoma of the salivary glands is important for their management. We studied the expression of several myoepithelial and basal/stem cell markers (smooth muscle actin, calponin, smooth muscle myosin heavy chain, metallothionein, maspin, and p63) by immunohistochemistry in 23 adenoid cystic carcinoma and 24 polymorphous low-grade adenocarcinoma, to identify the most useful marker or combination of markers that may help their diagnoses. The results were analyzed using hierarchical cluster analysis and chi(2) test for trend. We noted diffuse expression of smooth muscle actin in 20 adenoid cystic carcinoma vs one polymorphous low-grade adenocarcinoma (P<0.0001), calponin in 15 adenoid cystic carcinoma vs one polymorphous low-grade adenocarcinoma (P<0.0001), smooth muscle myosin heavy chain in 15 adenoid cystic carcinoma vs one polymorphous low-grade adenocarcinoma (P=0.001), metallothionein in 22 adenoid cystic carcinoma vs eight polymorphous low-grade adenocarcinoma (P<0.001), maspin in 22 adenoid cystic carcinoma vs 14 polymorphous low-grade adenocarcinoma, and p63 in 21 adenoid cystic carcinoma vs 14 polymorphous low-grade adenocarcinoma. Hierarchical clustering of smooth muscle actin, calponin, smooth muscle myosin heavy chain, and metallothionein was virtually identical (kappa< or =0.0035), suggesting no significant advantage to their use in combination than individually. Diffuse smooth muscle actin expression showed the highest accuracy (91.5%) and positive predictive value (95.2%) for adenoid cystic carcinoma. Thus, diffuse expression of smooth muscle actin, calponin, smooth muscle myosin heavy chain, and metallothionein was highly predictive of adenoid cystic carcinoma, whereas maspin and p63 were frequently expressed in both tumors. In differentiating adenoid cystic carcinoma from polymorphous low-grade adenocarcinoma, smooth muscle actin as a single ancillary test in support of the histological findings, appears to be as efficient as multiple immunohistochemical tests.
区分涎腺腺样囊性癌和多形性低度恶性腺癌对于其治疗很重要。我们通过免疫组织化学研究了23例腺样囊性癌和24例多形性低度恶性腺癌中几种肌上皮和基底/干细胞标志物（平滑肌肌动蛋白、钙调蛋白、平滑肌肌球蛋白重链、金属硫蛋白、乳腺丝抑蛋白和p63）的表达，以确定可能有助于其诊断的最有用标志物或标志物组合。使用层次聚类分析和趋势卡方检验对结果进行分析。我们注意到20例腺样囊性癌中有平滑肌肌动蛋白的弥漫性表达，而多形性低度恶性腺癌中只有1例（P<；0.0001）；15例腺样囊性癌中有钙调蛋白的表达，多形性低度恶性腺癌中只有1例（P<；0.0001）；15例腺样囊性癌中有平滑肌肌球蛋白重链的表达，多形性低度恶性腺癌中只有1例（P = 0.001）；22例腺样囊性癌中有金属硫蛋白的表达，8例多形性低度恶性腺癌中有金属硫蛋白的表达（P<；0.001）；22例腺样囊性癌中有乳腺丝抑蛋白的表达，14例多形性低度恶性腺癌中有乳腺丝抑蛋白的表达；21例腺样囊性癌中有p63的表达，14例多形性低度恶性腺癌中有p63的表达。平滑肌肌动蛋白、钙调蛋白、平滑肌肌球蛋白重链和金属硫蛋白的层次聚类几乎相同（kappa≤0.0035），表明它们联合使用并不比单独使用有显著优势。平滑肌肌动蛋白的弥漫性表达对腺样囊性癌显示出最高的准确性（91.5%）和阳性预测值（95.2%）。因此，平滑肌肌动蛋白、钙调蛋白、平滑肌肌球蛋白重链和金属硫蛋白的弥漫性表达对腺样囊性癌具有高度预测性，而乳腺丝抑蛋白和p63在两种肿瘤中均经常表达。在区分腺样囊性癌和多形性低度恶性腺癌时，平滑肌肌动蛋白作为支持组织学发现的单一辅助检查，似乎与多种免疫组化检查一样有效。
