NET的病理诊断天津.ppt

Fig. 1 Low power illustrating the conventional adenocarcinoma occupying the superficial aspects of the tumor while the more solid, sheet-like component is present in the deep aspects of the lesion (HE×50) Fig. 3 The large cell neuroendocrine component consisted of large polygonal to round cells with focal rosette formation (HE×400) 神经内分泌成分的分化程度差异比较大，可以高分化，也有可能是分化差的神经内分泌成分 除了腺癌成分外，也可以是鳞癌成分，但是比较罕见 腺癌中可存在少量散在内分泌细胞，不归入此型 免疫组化对NET诊断和预后非常重要 免疫组织化学染色法可 -识别NET细胞 -评估细胞增殖和浸润的潜力 -评估调节机制和治疗目标 免疫组织化学 (IHC)染色 大多数高分化NET表达一种或多种神经内分泌标记物 推荐用于大多数病例的诊断 NET常用的组织标记物 CgA 突触素 个别激素 (如胰岛素、胰高血糖素、生长抑素、胰多肽(PP)、 VIP) * IHC can also test for CgA, which can be detected in the secretory granules of most NET. Similarly to the problem we have with detecting blood levels of CgA in NET of the distal colon and rectum, the IHC for CgA is not sensitive for the large bowel and appendix tumours that secrete CgB since the most commercially available CgA antibodies do not cross-react. ?Reference: Taupenot L, Harper KL, O’Connor DT. N Engl J Med. 2003;348:1134-1149. ? * In contrast to CgA, synaptophysin is expressed independently of secretory granules and therefore useful in identifying poorly granulated and poorly differentiated NET that may not exhibit CgA staining. However, the specificity of this stain is moderate in that synaptophysin staining is not limited to neuroendocrine cells. Reference: Chetty R et al. Arch Pathol Lab Med 2008;132:1285-1289. * 嗜铬蛋白A，突触素，神经元特异性烯醇化酶----角色：组织病理学确认和分类； 作用：确认NET；敏感度：高 Ki-67 抗原----角色：增殖指数；作用：细胞增殖率的评估；敏感度：高 生长抑素受体（亚型1-5）------角色：激素受体；作用：评估生长抑素类似物治疗潜能；敏感度：高 Immunohistochemistry is an important tool for diagnosing NET. It is recommended for the diagnosis in the majority of cases. This technique uses antibodies to detect and visualize antigens in cells and tissues via an immunofluorescence technique, which has largely replaced the immunoenzyme silver-based histochemical stains. The majority of well-differentiated NET express 1 or more neuroendocrine markers.