摘要
目的分析肾上腺皮质癌的临床病理特征及其网状纤维染色的价值。方法选取32例肾上腺皮质癌患者设为观察组,另选同期的30例肾上腺皮质腺瘤患者设为对照组。所有患者均经组织学检查,并进行网状纤维染色。比较两组病程、肿瘤最大直径、Weiss积分、临床病理特征及免疫表型。结果观察组病程(5.18±1.05)个月短于对照组的(20.63±6.28)个月,肿瘤最大直径(10.13±2.15)cm大于对照组的(2.59±0.35)cm,Weiss积分(5.14±0.62)分高于对照组的(0.92±0.15)分,差异具有统计学意义(P<0.05)。对照组瘤细胞的排列多呈巢团状、粗梁状,胞质嗜酸或透明,无显著的核异型,仅少量的出现核分裂,未出现包膜、静脉、窦隙侵犯,无明显的粗大胶原纤维、出血、坏死等异常情况,肿瘤网状纤维结构均保持规则完整,没有出现断裂、稀疏、塌陷或消失的情况。观察组癌细胞的排列多呈巢团状、条索状、粗梁状或弥漫性,大部分均为胞质嗜酸性,有明显的核异型以及非典型核分裂,同时存在包膜、静脉、窦隙侵犯,且容易查见出血、坏死、粗大胶原纤维,出现明显的网状纤维结构破坏,且出现程度不一的断裂、稀疏、塌陷或消失。观察组核异型Ⅲ+Ⅳ型、核分裂数>5个/50HPF、透明细胞比例<25%、肿瘤坏死、静脉侵犯、窦隙侵犯、包膜侵犯、粗大胶原纤维、网状纤维支架破坏占比均高于对照组,差异具有统计学意义(P<0.05)。两组Vimentin、Syn、NSE、CK、CR、Melan-A、α-inhibin的表达比较无明显差异(P>0.05)。结论肾上腺皮质癌存在明显特征的免疫表型,通过体积、胶原纤维的粗细程度、是否发生远处转移以及有无出现网状纤维结构破坏等方面均有利于判断病情,并与肾上腺皮质腺瘤区分。
Objective To analyze the clinicopathological features of adrenal cortical carcinoma and the value of reticular fiber staining.Methods 32 patients with adrenal cortical carcinoma were selected as the observation group,and another 30 patients with adrenal cortical adenoma in the same period were selected as the control group.All patients underwent histological examination and reticular fiber staining.The course of disease,maximum diameter of the tumor,Weiss score,clinicopathological features and immunophenotype were compared between the two groups.Results In the observation group,the course of disease was(5.18±1.05)months,which was shorter than(20.63±6.28)months in the control group;the maximum diameter of the tumor was(10.13±2.15)cm,which was greater than(2.59±0.35)cm in the control group;the Weiss score was(5.14±0.62)points,which was higher than(0.92±0.15)points in the control group;the difference was statistically significant(P<0.05).In the control group,the tumor cells were mainly characterized by nests and clusters,arranged in a rough beam like manner,with eosinophilic or transparent cytoplasm,no significant nuclear abnormalities,only a small amount of nuclear division,no capsule,venous invasion,sinus space,and no obvious abnormal conditions such as large collagen fibers,bleeding,and necrosis,and the tumor reticular fiber structure remained regular and complete,without fracture,thinning,collapse or disappearance.In the observation group,the arrangement of cancer cells was characterized by nest like,cord like,trabecular or diffuse patterns,with most of them being cytoplasmic eosinophilic,exhibiting obvious nuclear atypia and atypical nuclear division;there was also invasion of the capsule,vein,and sinus space,and bleeding,necrosis,and coarse collagen fibers were easily detected;there was obvious destruction of reticulofibrillar structure,and varying degrees of rupture,sparseness,collapse,or disappearance.The percentage of nuclear abnormalitiesⅢ+Ⅳ,number of nuclear divisions>5/50 HPF,percentage of clear cells<25%,percentages of tumor necrosis,venous invasion,sinus invasion,capsular invasion,coarse collagen fibers,reticular fibrous structure destruction in the observation group was higher than those of the control group,and the difference was statistically significant(P<0.05).There were no significant differences in the expression of Vimentin,Syn,NSE,CK,CR,Melan-A andα-inhibin between the two groups(P>0.05).Conclusion Adrenal cortical carcinoma has a distinct immunophenotype,which can be distinguished from adrenal cortical adenoma by factors such as volume,thickness of collagen fibers,presence of distant metastasis,and presence of reticular fiber structure destruction,and distinguish it from adrenal cortical adenoma.
作者
管雅洁
田一辰
GUAN Ya-jie;TIAN Yi-chen(Department of Pathology,First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)
出处
《中国实用医药》
2025年第11期67-70,共4页
China Practical Medicine
关键词
肾上腺皮质癌
肾上腺皮质腺瘤
病理特征
网状纤维染色
价值
Adrenal cortical carcinoma
Adrenocortical adenoma
Pathological characteristics
Reticular fiber staining
Value
