目的 探讨胰岛素瘤相关蛋白1(insulinoma-associated protein 1,INSM1)在嗜铬细胞瘤/副神经节瘤和肾上腺皮质腺瘤中的表达及其在鉴别诊断中的意义.方法 采用免疫组化EnVision两步法检测INSM1在嗜铬细胞瘤/副神经节瘤和肾上腺皮质腺瘤中的表达.结果 32例嗜铬细胞瘤中31例INSM1阳性(31/32,96.88％),其中高表达20例(20/32,62.50％).9例肾上腺外副神经节瘤INSM1均阳性,其中高表达8例(8/9,88.89％).33例肾上腺皮质腺瘤中INSM1均阴性.INSM1在嗜铬细胞瘤/副神经节瘤中的表达显著高于肾上腺皮质腺瘤(P＜0.001).INSM1高表达的嗜铬细胞瘤/副神经节瘤具有更高的Ki67增殖指数(P=0.016),但与患者性别(P=0.190)、年龄(P=0.439)、肿瘤TNM分期(P=0.793)、生长模式(P=0.495)、凝固性坏死(P=0.790)和脉管/包膜侵犯(P=0.790)均无显著相关性.INSM1鉴别嗜铬细胞瘤/副神经节瘤与肾上腺皮质腺瘤的敏感性为97.6％,特异性为100％,ROC曲线下面积为0.988.结论 INSM1表达于嗜铬细胞瘤和副神经节瘤的细胞核,而不表达于肾上腺皮质腺瘤,可有效鉴别嗜铬细胞瘤/副神经节瘤和肾上腺皮质腺瘤.
Expression of INSM1 in pheochromocytoma/paraganglioma and adrenocortical adenoma and its pathological diagnostic value
Purpose To investigate the expression of insu-linoma-associated protein 1(INSM1)in pheochromocytoma/paraganglioma and adrenocortical adenoma,and its significance in differential diagnosis.Methods Immunohistochemical En-Vision two-step method was used to detect the expression of IN-SM1 in pheochromocytoma/paraganglioma and adrenocortical ad-enoma.Results In 32 cases of pheochromocytoma,31 cases were positive for INSM1(31/32,96.88％),of which INSM1 was highly expressed in 20 cases(20/32,62.50％).Nine ca-ses of extraadrenal paraganglioma were all positive for INSMl,of which INSM1 was highly expressed in 8 cases(8/9,88.89％).The expression of INSM1 was negative in 33 cases of adrenocor-tical adenoma.The expression rate of INSM1 in pheochromocy-toma/paraganglioma was significantly higher than that in adreno-cortical adenoma(P＜0.001).The expression level of INSM1 was positively associated with Ki67 index(P=0.016),but not correlated with gender(P=0.190),age(P=0.439),TNM stage(P=0.436),growth pattern(P=0.495),coagulation necrosis(P=0.790),and vascular/capsule invasion(P=0.790).The sensitivity of INSM1 in differentiating pheochromo-cytoma/paraganglioma from adrenocortical adenoma was 97.6％,and the specificity was 100％.The area under the re-ceiver operating characteristic(ROC)curve was 0.988.Con-clusion INSM1 is expressed in the nuclei of pheochromocyto-ma/paraganglioma,but not expressed in adrenocortical adeno-ma.So,INSM1 can be used as an effective marker to distin-guish pheochromocytoma/paraganglioma from adrenocortical ade-noma.
万方数据
维普
