Cao Z, Cen H B, Zhao J H, Mei J, Qin L Z, Liao W, Ao Q L
Department of Pathology, Huanggang Central Hospital, Huanggang 438000, Hubei, China.
Department of Thyroid and Breast Surgery, Huanggang Central Hospital, Huanggang 438000, Hubei, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2023 Aug 18;55(4):575-581. doi: 10.19723/j.issn.1671-167X.2023.04.001.
To investigate the expression and significance of insulinoma associated protein 1 (INSM1) and SRY-related high-mobility group box 11 (SOX11) in pancreatic neuroendocrine tumor (PNET) and solid pseudopapillary neoplasm (SPN).
To detect the expression of INSM1, SOX11, Syn, CgA, CD56, β-catenin, and CD99 in 56 cases of PNET, 42 cases of SPN, 16 cases of ductal adenocarcinoma (DACC) and 8 cases of acinar cell carcinoma (ACC) by immunohistochemistry. The application value of combination of INSM1 and SOX11 was compared with conventional markers (Syn, CgA, CD56, β-catenin, and CD99) in diagnosis and differential diagnosis of PNET and SPN.
(1) In the 56 cases of PNET, the positive signals of INSM1 were located in the tumor and islet nucleus, the positive expression rate in the tumor tissues was 91.07% (51/56), whereas the signal was absent in 42 cases of SPN, 16 cases of DACC and 8 cases of ACC, and there were significant statistical difference between PNET with SPN, DACC, and ACC respectively ( < 0.001). (2) The positive signals of SOX11 were located in the tumor nucleus, with the positive expression rate was 92.86% (39/42) in SPN, however, the positive expression rate of SOX11 was 8.93% (5/56) in PNET, which included 3 cases of G and 2 cases of G types of PNET, the SOX11 positive signal was absent in 16 cases of DACC, 8 cases of ACC and peritumoral nomal pancreatic tissue, and the differences were statistically significant of positive rate between SPN with PNET, DACC and ACC, respectively ( < 0.001). (3) The sensitivity of INSM1(+)/SOX11(-) immunophenotype for PNET was 85.71%, CD56 (57.14%), the difference was statistically significant (=0.001); Syn (80.36%) and CgA (71.43%), the difference was no statistically significant (>0.05). The specificity of INSM1(+)/SOX11(-) for PNET was 100.00%, Syn (42.86%) and CD56 (47.62%), the difference was statistically significant ( < 0.001); CgA (92.86%), the difference was no statistically significant (>0.05). The sensitivity of INSM1(-)/SOX11(+) immunophenotype for SPN was 92.86%, β-catenin (90.48%) and CD99 (85.71%), the difference was no statistically significant (>0.05). The specificity of INSM1(-)/SOX11(+) for SPN was 96.43%, CD99 (48.21%), the difference was statistically significant ( < 0.001); β-catenin (100.00%), the difference was no statistically significant (>0.05). (4) The positive expression of INSM1 and SOX11 in PNET and SOX11 were not correlated with clinicopathological parameters (age, gender, tumor size, location, grade, and metastasis) (>0.05).
The positive expression patterns of INSM1 and SOX11 in PNET and SPN respectively are conductive to distinguish the both tumors. The combination of both take precedence over some corresponding conventional immunohistochemical markers in terms of sensitivity and specificity.
探讨胰岛素瘤相关蛋白1（INSM1）和SRY相关高迁移率族盒蛋白11（SOX11）在胰腺神经内分泌肿瘤（PNET）和实性假乳头状瘤（SPN）中的表达及意义。
采用免疫组织化学法检测56例PNET、42例SPN、16例导管腺癌（DACC）和8例腺泡细胞癌（ACC）中INSM1、SOX11、Syn、CgA、CD56、β-连环蛋白和CD99的表达。比较INSM1和SOX11联合应用与传统标志物（Syn、CgA、CD56、β-连环蛋白和CD99）在PNET和SPN诊断及鉴别诊断中的应用价值。
（1）56例PNET中，INSM1阳性信号位于肿瘤细胞核及胰岛细胞核，肿瘤组织中阳性表达率为91.07%（51/56），而42例SPN、16例DACC和8例ACC中均无信号，PNET与SPN、DACC、ACC之间差异均有统计学意义（<0.001）。（2）SOX11阳性信号位于肿瘤细胞核，SPN中阳性表达率为92.86%（39/42），而PNET中SOX11阳性表达率为8.93%（5/56），其中包括3例G1和2例G2型PNET，16例DACC、8例ACC及瘤旁正常胰腺组织中均无SOX11阳性信号，SPN与PNET、DACC、ACC之间阳性率差异均有统计学意义（<0.001）。（3）INSM1(+)/SOX11(-)免疫表型对PNET的敏感性为85.71%，CD56为57.14%，差异有统计学意义（=0.001）；Syn为80.36%，CgA为71.43%，差异无统计学意义（>0.05）。INSM1(+)/SOX11(-)对PNET的特异性为100.00%，Syn为42.86%，CD56为47.62%，差异有统计学意义（<0.001）；CgA为92.86%，差异无统计学意义（>0.05）。INSM1(-)/SOX11(+)免疫表型对SPN的敏感性为92.86%，β-连环蛋白为90.48%，CD99为85.71%，差异无统计学意义（>0.05）。INSM1(-)/SOX11(+)对SPN的特异性为96.43%，CD99为48.21%，差异有统计学意义（<0.001）；β-连环蛋白为100.00%，差异无统计学意义（>0.05）。（4）PNET中INSM1和SOX11的阳性表达与临床病理参数（年龄、性别、肿瘤大小、位置、分级和转移）无关（>0.05）。
INSM1和SOX11在PNET和SPN中的阳性表达模式分别有助于两者的鉴别诊断。两者联合应用在敏感性和特异性方面优于一些相应的传统免疫组化标志物。
