Gill Ryan, O'Donnell Richard J, Horvai Andrew
Department of Laboratory Medicine, University of California, San Francisco, USA.
Arch Pathol Lab Med. 2009 Jun;133(6):967-72. doi: 10.5858/133.6.967.
Epithelioid hemangioendothelioma (EHE) is a rare vascular neoplasm of intermediate malignancy. Epithelioid hemangioendothelioma often presents a difficult diagnostic problem, especially in bone, because the epithelioid morphology and radiographic features raise the possibility of metastatic carcinoma. The current trend of small biopsies obtained with computed tomography-guided techniques exacerbates the problem. The markedly different treatment for EHE and metastatic carcinoma underscores the need for specific markers that can differentiate between these 2 entities.
To determine the relative utility of endothelial markers in differentiating EHE from metastatic carcinoma, with emphasis on bone biopsies.
We used immunohistochemistry in formalin-fixed paraffin-embedded tissue to compare the utility of Fli-1, CD34, CD31, podoplanin, and keratin cocktail in 13 EHEs and 13 morphologically similar carcinomas metastatic to bone. Immunohistochemical data were evaluated using Fisher exact test, and specificity and sensitivity were calculated.
Significant proportions of EHEs were positive for Fli-1 (100%), CD34 (85%), and CD31 (100%) compared with metastatic carcinoma (Fli-1, 15%; CD34, 15%; CD31, 38%) (P < .001, P = .005, and P = .01, respectively). However, these markers were not 100% specific for EHE. Cytokeratin cocktail stained significantly more metastatic carcinomas (100%) than EHEs (38%) (P = .01) but was not 100% specific. No significant difference was observed regarding immunostaining for podoplanin between the tumor types.
Fli-1 is most helpful in distinguishing EHE from metastatic carcinoma. However, the absence of complete specificity of any of the endothelial markers for EHE, or of keratin cocktail for carcinoma, suggests that these markers are best used in combination.
上皮样血管内皮瘤（EHE）是一种罕见的具有中等恶性程度的血管肿瘤。上皮样血管内皮瘤常常带来诊断难题，尤其是在骨骼中，因为其上皮样形态和影像学特征会增加转移性癌的可能性。当前通过计算机断层扫描引导技术获取小活检样本的趋势加剧了这一问题。EHE与转移性癌的治疗方法明显不同，这凸显了需要能够区分这两种实体的特异性标志物。
确定内皮标志物在鉴别EHE与转移性癌中的相对效用，重点关注骨活检。
我们在福尔马林固定石蜡包埋组织中使用免疫组织化学方法，比较Fli-1、CD34、CD31、足板蛋白和细胞角蛋白混合物在13例EHE和13例形态学上相似的骨转移性癌中的效用。使用Fisher精确检验评估免疫组织化学数据，并计算特异性和敏感性。
与转移性癌相比，EHE中有相当比例的病例Fli-1呈阳性（100%）、CD34呈阳性（85%）和CD31呈阳性（100%）（Fli-1，15%；CD34，15%；CD31，38%）（P <.001、P =.005和P =.01）。然而，这些标志物对EHE并非100%特异。细胞角蛋白混合物染色的转移性癌（100%）明显多于EHE（38%）（P =.01），但也不是100%特异。在肿瘤类型之间，足板蛋白免疫染色未观察到显著差异。
Fli-1在区分EHE与转移性癌方面最有帮助。然而，任何内皮标志物对EHE或细胞角蛋白混合物对癌均缺乏完全特异性，这表明这些标志物最好联合使用。
