Christensen W N, Strong E W, Bains M S, Woodruff J M
Department of Pathology, Memorial Hospital for Cancer and Allied Diseases, New York, NY 10021.
Am J Surg Pathol. 1988 Jun;12(6):417-26. doi: 10.1097/00000478-198806000-00001.
We studied eight glandular peripheral nerve sheath tumors and seven biphasic synovial sarcomas with glands with the objectives of (a) characterizing the nerve sheath tumors, especially with respect to a possible neuroendocrine differentiation, and (b) identifying features that could be used to distinguish between the two lesions. In a mainly immunohistochemical study, neuroendocrine differentiation of glandular cells was observed in five of eight (62.5%) nerve sheath tumors. The neuroendocrine cell markers found included chromogranin (five of eight cases), serotonin (four of seven cases), pancreatic polypeptide (two of five cases), and gastrin (two of six cases). These findings--together with histological, histochemical, and ultrastructural observations made in this and in other studies--point to a foregut type of intestinal differentiation for the glands in a majority of glandular peripheral nerve sheath tumors. Specific histological and immunohistochemical differences between the nerve sheath tumors and the synovial sarcomas were identified. The main histological differences were a sharp distinction between the spindle and glandular cells of the former but not the latter lesion, and the presence of goblet-type cells only in the glandular peripheral nerve sheath tumors. Major immunohistochemical differences included neuroendocrine differentiation and reactivity for S-100 protein and CEA (seen only or mainly in the nerve sheath tumors), and the reactivity of spindle cells of only the biphasic synovial sarcomas for epithelial membrane antigen.
我们研究了8例腺性外周神经鞘瘤和7例伴有腺成分的双相性滑膜肉瘤，目的是：(a) 对神经鞘瘤进行特征描述，特别是关于可能的神经内分泌分化；(b) 确定可用于区分这两种病变的特征。在一项主要为免疫组织化学的研究中，8例神经鞘瘤中有5例（62.5%）观察到腺细胞的神经内分泌分化。发现的神经内分泌细胞标志物包括嗜铬粒蛋白（8例中的5例）、血清素（7例中的4例）、胰多肽（5例中的2例）和胃泌素（6例中的2例）。这些发现——连同本研究及其他研究中的组织学、组织化学和超微结构观察结果——表明大多数腺性外周神经鞘瘤中的腺体具有前肠型肠分化。确定了神经鞘瘤和滑膜肉瘤之间特定的组织学和免疫组织化学差异。主要的组织学差异是前者的梭形细胞和腺细胞之间有明显区分，而后者病变则没有，且杯状细胞仅存在于腺性外周神经鞘瘤中。主要的免疫组织化学差异包括神经内分泌分化以及对S-100蛋白和癌胚抗原的反应性（仅在或主要在神经鞘瘤中可见），以及仅双相性滑膜肉瘤的梭形细胞对上皮膜抗原的反应性。
