Yaziji H, Massarani-Wafai R, Gujrati M, Kuhns J G, Martin A W, Parker J C
Department of Pathology, University of Louisville Medical Center, KY, USA.
Am J Surg Pathol. 1996 Sep;20(9):1086-90. doi: 10.1097/00000478-199609000-00006.
P53 immunohistochemistry has been used to distinguish between malignant tumors and morphologically similar benign processes. In the central nervous system, a major diagnostic dilemma is caused by overlapping features of benign reactive astrocytic lesions and low-grade astrocytomas, especially with small biopsies. P53 immunoreactivity in astrocytes could be useful in differentiating benign reactive lesions from malignant astrocytomas. An immunohistochemical study on 110 brain lesions from 108 patients using a monoclonal antibody (DO-7) against p53 protein was conducted. Using the modified Ringertz and World Health Organization system, the specimens included 22 astrocytomas, 12 anaplastic astrocytomas, 42 glioblastoma multiforme tumors, three nonglial tumors, and 56 reactive astrocytic lesions to 25 neoplasms, nine infectious processes, six cerebrovascular disorders,one metabolic disorder, two vascular malformations, eleven degenerative/demyelinating lesions, and two unknown primary lesions. Immunoreactive astrocytic tumors included 12 (54%) astrocytomas, nine (75%) anaplastic astrocytomas, and 38 glioblastoma multiforme tumors (90%). Among the reactive astrocytic lesions, only five (9%) cases of progressive multifocal leukoencephalopathy were immunoreactive. These data demonstrate that p53 immunoreactivity in astrogliosis is unusual but is to be expected in astrocytomas and can help to differentiate reactive from neoplastic astrocytic lesions.
P53免疫组化已被用于区分恶性肿瘤与形态学上相似的良性病变。在中枢神经系统中，良性反应性星形细胞病变和低级别星形细胞瘤的特征重叠会引发一个主要的诊断难题，尤其是在小活检标本中。星形细胞中的P53免疫反应性可能有助于鉴别良性反应性病变与恶性星形细胞瘤。本研究使用针对p53蛋白的单克隆抗体（DO-7），对108例患者的110个脑病变进行了免疫组化研究。按照改良的林格茨和世界卫生组织系统，标本包括22例星形细胞瘤、12例间变性星形细胞瘤、42例多形性胶质母细胞瘤、3例非神经胶质肿瘤，以及针对25例肿瘤、9例感染性病变、6例脑血管疾病、1例代谢紊乱、2例血管畸形、11例变性/脱髓鞘病变和2例原发灶不明病变的56例反应性星形细胞病变。免疫反应性星形细胞瘤包括12例（54%）星形细胞瘤、9例（75%）间变性星形细胞瘤和38例（90%）多形性胶质母细胞瘤。在反应性星形细胞病变中，仅5例（9%）进行性多灶性白质脑病呈免疫反应性。这些数据表明，星形细胞增生中的p53免疫反应性并不常见，但在星形细胞瘤中可以预期，并且有助于鉴别反应性与肿瘤性星形细胞病变。
