骶骨脊索瘤55例临床病理和免疫表型分析

摘要

目的 探讨骶骨脊索瘤的临床病理特征,观察CK、vimentin、S-100蛋白及Ki-67在脊索瘤中的表达.方法 收集2007～2011年北京大学人民医院病理科存档的55例脊索瘤,分析其临床病理学特征,并采用免疫组化EnVision两步法检测CK、vimentin、S-100蛋白及Ki-67的表达.结果 55例骶骨脊索瘤患者中原发病例35例,复发病例20例,男女之比为2.2:1.发病年龄21～85岁,平均52.8岁.大部分病例主要呈结节状生长,局灶呈巢片状排列.肿瘤细胞主要由液滴状及星芒状细胞组成,细胞轻-中度异型,偶见核分裂,少部分病例可见坏死.免疫表型:CK、vimentin和S-100蛋白的阳性率分别为96.4%(53/55)、100%(55/55)、94.5%(52/55),Ki-67增殖指数为2%～25%.原发和继发的脊索瘤中CK、vimentin、S-100及Ki-67的表达无明显差异(P>0.05).结论 骶骨脊索瘤是一种易复发的低度恶性肿瘤,CK、vimentin、S-100蛋白结合Ki-67的免疫组化标记可辅助诊断脊索瘤.%Purpose To investigate the clinicopathologic features and the expression of CK, vimentin, S-100 and Ki-67 on patients with sacral chordoma. Methods 55 cases diagnosed as chordoma with available slides and clinical information, coded between 2007 and 2011, were retrieved from the our department of pathology. The expression of CK, vimentin, S-100 and Ki-67 were examined using immunohistochemistry. Results Of the 55 cases, 35 were primary and 20 were recurrent cases. The ratio of males to females is 2. 2 ? 1. The age ranged from 21 to 85 years ( median, 52. 8 years ). The majority of the tumor showed nodular growth pattern, focally with nests. The neoplasm were composed of physaliphorous cells and satellite-like cells. The tumor cells revealed mild to moderate atypia and the mitosis was rare. The focal necrosis was observed in a minority of cases. Immunohistochemistry was performed in 55 chordoma cases including 35 primary and 20 secondary cases. Immunohistochemical finding showed that the expression of CK, vimentin, S-100 were detected in 96. 4%( 53/55 ), 100%( 55/55 ), 94. 5%( 52/55 ) cases, respectively. The index of Ki-67 ranged from 2 to 25% . No significant difference between primary and secondary chordoma cases in the expression of CK, vimentin, S-100 and Ki-67 was found ( P > 0. 05 ). Conclusions The chordoma is a kind of low grade malignant tumor and susceptible to recurrence. The combination detection with CK, vimentin, S-100 and Ki-67 may be adjunct to pathologic diagnosis of chordoma.