J Ashraf Mohammad, Beigomi Leila, Azarpira Negar, Geramizadeh Bita, Khademi Bijan, Hakimzadeh Afsoon, Abedi Elham
Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, IR Iran.
Department of Otolaryngology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, IR Iran.
Iran Red Crescent Med J. 2013 Jun;15(6):455-61. doi: 10.5812/ircmj.4735. Epub 2013 Jun 5.
Primary Small round blue cell tumors (SRBCT) in sinonasal comprise histogenetically diverse entities with overlapping morphologic features. Because of the limited initial biopsy tissue materials, differential diagnostic difficulties may arise, and as they have different management, exact diagnosis and classification are very important.
In this study, we analyzed the immunohistochemical expression of a panel of markers in the classification and diagnosis of sinonasal SRBCTs.
This cross sectional study was performed on 36 paraffin embedded tissue samples. Histologic and immunohistochemical slides from 36 patients with SRBCT were analyzed retrospectively. The patients were admitted in Khalili hospital, Shiraz from 1383 to 1388.
There were 13 women and 23 men with the mean age of 53 ±12.1. There were 9 malignant melanoma, seven poorly differentiated SCC; six lymphoma (DLBL); 4 SCNEC; three SNUC; two ON; two Ewing/PNET; two embryonal rhabdomyosarcoma, and one plasmacytoma. Pan-cytokeratin was strongly expressed poorly differentiated SCC and all cases of SNUC. Coexpression of desmin and nuclear myoD1 was only detected in rhabdomyosarcoma. HMB45 was only expressed in sinonasal melanoma. CD99 expression was identified only in Ewing/PNET. FLI-1 was detected in 50% of PNET. P63 was expressed in poorly differentiated SCC (2/7) and SNUC (1/3).
The results of our study indicate that the integration of histopathologic findings with application of limited but highly specific markers led to the separation of carcinomas, lymphoma and melanomas from other small cell tumors. Using a panel of keratin, LCA, desmin, and HMB45 is the most practical and economic approach to accurately classify these tumors.
鼻窦原发性小圆蓝细胞瘤（SRBCT）在组织发生学上包含形态学特征重叠的不同实体。由于初始活检组织材料有限，可能会出现鉴别诊断困难，并且由于它们有不同的治疗方法，准确的诊断和分类非常重要。
在本研究中，我们分析了一组标志物的免疫组化表达在鼻窦SRBCT分类和诊断中的作用。
本横断面研究对36个石蜡包埋组织样本进行。回顾性分析36例SRBCT患者的组织学和免疫组化切片。这些患者于1383年至1388年在设拉子的哈利利医院就诊。
有13名女性和23名男性，平均年龄为53±12.1岁。有9例恶性黑色素瘤；7例低分化鳞状细胞癌；6例淋巴瘤（弥漫性大B细胞淋巴瘤）；4例鼻窦神经内分泌癌；3例鼻窦未分化癌；2例嗅神经母细胞瘤；2例尤因肉瘤/原始神经外胚层肿瘤；2例胚胎性横纹肌肉瘤和1例浆细胞瘤。全细胞角蛋白在低分化鳞状细胞癌和所有鼻窦未分化癌病例中强烈表达。结蛋白和核肌分化抗原1（myoD1）的共表达仅在横纹肌肉瘤中检测到。HMB45仅在鼻窦黑色素瘤中表达。CD99表达仅在尤因肉瘤/原始神经外胚层肿瘤中鉴定到。FLI-1在50%的原始神经外胚层肿瘤中检测到。P63在低分化鳞状细胞癌（2/7）和鼻窦未分化癌（（1/3）中表达。
我们的研究结果表明，将组织病理学结果与应用有限但高度特异性的标志物相结合，可将癌、淋巴瘤和黑色素瘤与其他小细胞肿瘤区分开来。使用一组角蛋白（keratin）、白细胞共同抗原（LCA）、结蛋白（desmin）和HMB45是准确分类这些肿瘤的最实用和经济的方法。
