Kliewer K E, Wen D R, Cancilla P A, Cochran A J
Department of Pathology, Century City Hospital, Los Angeles, CA 90067.
Hum Pathol. 1989 Jan;20(1):29-39. doi: 10.1016/0046-8177(89)90199-8.
To predict clinical outcome, we studied 42 paragangliomas from 37 patients by routine histology, immunohistochemistry, and electron microscopy. A panel of antisera to neuron-specific enolase (NSE), chromogranin, and met-enkephalin was used to identify chief (type I) cells, and S-100 protein and glial fibrillary acid protein (GFAP) sustentacular (type II) cells. The intensity of staining of type I cells and the density of type II cells were assessed semiquantitatively (0 to 4+) in a total of 38 tumors. A total of 23 of 24 low-grade tumors (solitary, multiple, or associated with other neoplasms; 95.8%) contained type II cells immunoreactive with either S-100 protein or GFAP, and all were positive when S-100 protein and GFAP were used in combination. Five of the nine intermediate-grade (recurrent and/or locally aggressive) tumors were identified as glomus jugulare tumors (GJT). Three intermediate-grade GJTs were devoid of GFAP-reactive type II cells and four GJTs were negative for S-100 protein. Type II cells were identified in only one of five high-grade (malignant) paragangliomas and that tumor contained vanishingly rare cells that were weakly S-100 protein positive but GFAP negative. Sustentacular cell density and chief cell staining intensity were both inversely related to tumor grade. The most sensitive chief cell marker was NSE (92.1%), followed by chromogranin (84.2%). The least sensitive (73.0%) and specific marker was met-enkephalin. Combinations of NSE or chromogranin with met-enkephalin identified chief cells in all cases. Electron microscopy identified neurosecretory granule-containing chief cells, but was of less value in delineating sustentacular cells because of their scarcity and the absence of specific features. By comparison, immunohistochemistry was superior in identifying sustentacular cells. The use of an immunohistochemical panel, in addition to routine histology, can confirm the diagnosis of a paraganglioma and can give an indication of the likely prognosis for a patient.
为预测临床结果，我们通过常规组织学、免疫组织化学和电子显微镜对37例患者的42个副神经节瘤进行了研究。使用一组针对神经元特异性烯醇化酶（NSE）、嗜铬粒蛋白和甲硫氨酸脑啡肽的抗血清来识别主细胞（I型细胞），并用S-100蛋白和胶质纤维酸性蛋白（GFAP）来识别支持细胞（II型细胞）。在总共38个肿瘤中，对I型细胞的染色强度和II型细胞的密度进行了半定量评估（0至4+）。24个低级别肿瘤（孤立性、多发性或与其他肿瘤相关；95.8%）中的23个含有与S-100蛋白或GFAP免疫反应阳性的II型细胞，当联合使用S-100蛋白和GFAP时全部呈阳性。9个中级（复发性和/或局部侵袭性）肿瘤中有5个被鉴定为颈静脉球瘤（GJT）。3个中级GJT缺乏GFAP反应性II型细胞，4个GJT的S-100蛋白呈阴性。在5个高级别（恶性）副神经节瘤中，只有1个发现了II型细胞，且该肿瘤中此类细胞极其罕见，仅呈弱阳性的S-100蛋白阳性但GFAP阴性。支持细胞密度和主细胞染色强度均与肿瘤级别呈负相关。最敏感的主细胞标志物是NSE（92.1%），其次是嗜铬粒蛋白（84.2%）。最不敏感（73.0%）且特异性最低的标志物是甲硫氨酸脑啡肽。NSE或嗜铬粒蛋白与甲硫氨酸脑啡肽联合使用可在所有病例中识别主细胞。电子显微镜可识别含神经分泌颗粒的主细胞，但由于支持细胞数量稀少且缺乏特异性特征，在区分支持细胞方面价值较小。相比之下，免疫组织化学在识别支持细胞方面更具优势。除常规组织学外，使用免疫组织化学检测组合可确诊副神经节瘤，并可为患者的可能预后提供指示。
