Rüschoff J, Willemer S, Brunzel M, Trautmann M E, Frank M, Arnold R, Klöppel G
Department of Pathology, University of Regensburg, Germany.
Histopathology. 1993 Jan;22(1):51-7. doi: 10.1111/j.1365-2559.1993.tb00069.x.
The value of silver staining of nucleolar organizer regions (AgNORs) and human chorionic gonadotropin alpha-chain reaction (HCG-alpha) as markers of malignancy was investigated in 60 primary pancreatic endocrine tumours, 37 of which had metastasized at the time of surgery, and in one of which metastases developed 4 years after surgery. Assessment of AgNORs by digital image analysis revealed few but large AgNORs (mean number 2.5 +/- 1.1; mean area 0.32 +/- 0.1 microns 2) in the 22 benign tumours and many but small AgNORs (mean number 5.1 +/- 1.9, P < 0.05; mean area 0.18 +/- 0.09 microns 2, P < 0.01) in the malignant tumours. Quantification of the number of AgNORs per tumour cell nucleolus (AgNOR distribution score) showed that 96% (26/27) of tumours exhibiting at least 5% of cells with more than six AgNORs per nucleolus showed metastases either at the time of diagnosis or up to 4 years after surgery. HCG-alpha immunoreactive cells were present in 25/38 (66%) malignant tumours and in 4/22 (18%) benign tumours. Combined evaluation of AgNOR distribution and HCG-alpha scores showed a high positive predictive value of 96% in cases with a raised AgNOR distribution score irrespective of the HCG-alpha status. A good negative predictive value (81%) was, however, only obtained if both parameters, AgNOR distribution and HCG-alpha scores, were negative. Thus, investigation of AgNORs and HCG-alpha is helpful in predicting malignancy in a high percentage of pancreatic endocrine tumours.
在60例原发性胰腺内分泌肿瘤中研究了核仁组织区银染（AgNORs）和人绒毛膜促性腺激素α链反应（HCG-α）作为恶性肿瘤标志物的价值。其中37例在手术时已有转移，1例在手术后4年出现转移。通过数字图像分析评估AgNORs发现，22例良性肿瘤中AgNORs数量少但体积大（平均数量2.5±1.1；平均面积0.32±0.1平方微米），而恶性肿瘤中AgNORs数量多但体积小（平均数量5.1±1.9，P<0.05；平均面积0.18±0.09平方微米，P<0.01）。对每个肿瘤细胞核仁中AgNORs数量进行定量（AgNOR分布评分）显示，96%（26/27）每个核仁中至少5%的细胞具有6个以上AgNORs的肿瘤在诊断时或手术后4年内出现转移。HCG-α免疫反应性细胞存在于25/38（66%）的恶性肿瘤和4/22（18%）的良性肿瘤中。AgNOR分布和HCG-α评分的联合评估显示，无论HCG-α状态如何，AgNOR分布评分升高的病例中阳性预测值高达96%。然而，只有当AgNOR分布和HCG-α评分这两个参数均为阴性时，才能获得良好的阴性预测值（81%）。因此，对AgNORs和HCG-α的研究有助于预测大部分胰腺内分泌肿瘤的恶性程度。
