Tang Li, Zhou Jun, Jiang Zhi-ming, Zhang Hui-zhen, Liu Liang, Chen Jie
Department of Pathology, Shanghai Jiaotong University Affiliated the Sixth People's Hospital, Shanghai 200233, China.
Zhonghua Bing Li Xue Za Zhi. 2012 Mar;41(3):161-7. doi: 10.3760/cma.j.issn.0529-5807.2012.03.004.
Analyze the immunophenotype of the different cells in the various subtypes of giant cell tumor of tendon sheath (GCTS) and investigate the value of clusterin in pathological diagnosis and histogenesis of giant cell tumor of tendon sheath.
A total of 104 cases of GCTS from the surgical pathology files of Shanghai Jiaotong university affiliated the sixth people's hospital were identified. Immunohistochemistry (IHC) for clusterin, desmin, CD163, CD68, p63, p53, Ki-67 and CD35 was performed on all cases, using EnVision technique.
All cases of GCTS were researched, including 44 cases of localized type (L-GCTS), 32 cases of diffused type (D-GCTS), 26 cases of pigmented villonodular synovitis (PVNS) and 2 cases of malignant type. There was a slight female predominance in all these subtypes, and the male to female ratio was about 38:66. L-GCTS usually occured within the small joints (90.9%, 40/44), while D-GCTS, PVNS and M-GCTS commonly occured within the large weight-bearing joints [68.8% (22/32), 100% (26/26) and 2/2 respectively]. Of 74 cases with follow-up, the recurrence rates of L-GCTS, D-GCTS, PVNS and M-GCTS respectively were 30.3% (10/33), 30.4% (7/23), 18.8% (3/16) and 2/2. The different subtypes of GCTS had the same cell components, including the large synovial-like mononuclear cells, the small histiocytoid cells, foamy histiocytes cells, inflammatory cells, fibroblasts and the osteoclast-like multinucleated giant cells. There were obvious differences among immunophenotype of the various cell components in GCTS: the large synovial-like mononuclear cells were strong positive for clusterin, partly positive for desmin and Ki-67, and negative for CD163. The small histiocytoid cells were strong positive for CD163 but negative for clusterin and desmin. The osteoclast-like multinucleated giant cells were strong positive for CD68 but negative for clusterin, CD163 and desmin. Normal synoviocytes were strong positive for clusterin, partly positive for desmin. The number of the large synovial-like mononuclear cells that were positive for clusterin in D-GCTS were more than that in L-GCTS (P < 0.01) and PVNS (P < 0.05).
GCTS was synovial tumors, not belonged to the category of fibrohistiocytic lesions. The true tumor cells may be the large synovial-like mononuclear cells, and the number of the cells in the D-GCTS was obviously more than that in L-GCTS and PVNS. This may be the reason that the biological behavior of D-GCTS was more aggressive, destructive and recurrent. Clusterin was an useful marker in pathological differential diagnosis of GCTS.
分析腱鞘巨细胞瘤（GCTS）各亚型中不同细胞的免疫表型，探讨clusterin在腱鞘巨细胞瘤病理诊断及组织发生中的价值。
从上海交通大学附属第六人民医院手术病理档案中筛选出104例GCTS病例。所有病例均采用EnVision技术进行clusterin、结蛋白、CD163、CD68、p63、p53、Ki-67和CD35的免疫组织化学（IHC）检测。
共研究了104例GCTS病例，包括44例局限型（L-GCTS）、32例弥漫型（D-GCTS）、26例色素沉着绒毛结节性滑膜炎（PVNS）和2例恶性型。所有这些亚型中女性略占优势，男女比例约为38:66。L-GCTS通常发生于小关节（90.9%，40/44），而D-GCTS、PVNS和M-GCTS常见于大负重关节[分别为68.8%（22/32）、100%（26/26）和2/2]。74例有随访资料的病例中，L-GCTS、D-GCTS、PVNS和M-GCTS的复发率分别为30.3%（10/33）、30.4%（7/23）、18.8%（3/16）和2/2。GCTS各亚型具有相同的细胞成分，包括大的滑膜样单核细胞、小的组织细胞样细胞、泡沫状组织细胞、炎性细胞、成纤维细胞和破骨细胞样多核巨细胞。GCTS中各种细胞成分的免疫表型存在明显差异：大的滑膜样单核细胞clusterin强阳性，结蛋白和Ki-67部分阳性，CD163阴性。小的组织细胞样细胞CD163强阳性，但clusterin和结蛋白阴性。破骨细胞样多核巨细胞CD68强阳性，但clusterin、CD163和结蛋白阴性。正常滑膜细胞clusterin强阳性，结蛋白部分阳性。D-GCTS中clusterin阳性的大滑膜样单核细胞数量多于L-GCTS（P<0.01）和PVNS（P<0.05）。
GCTS是滑膜肿瘤，不属于纤维组织细胞病变范畴。真正的肿瘤细胞可能是大的滑膜样单核细胞，D-GCTS中该细胞数量明显多于L-GCTS和PVNS。这可能是D-GCTS生物学行为更具侵袭性、破坏性和复发性的原因。Clusterin是GCTS病理鉴别诊断的有用标志物。
