Utility of Immunohistochemistry for Endothelial Markers in Distinguishing Epithelioid Hemangioendothelioma From Carcinoma Metastatic to Bone
Utility of Immunohistochemistry for Endothelial Markers in Distinguishing Epithelioid Hemangioendothelioma From Carcinoma Metastatic to Bone
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DOI：
10.1043/1543-2165-133.6.967
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发表时间：
2009-06-01
影响因子：
4.6
通讯作者：
Horvai, Andrew
中科院分区：
文献类型：
--
作者：
Gill, Ryan;O'Donnell, Richard J.;Horvai, Andrew
背景：上皮样血管内皮瘤（EHE）是一种罕见的中度恶性血管肿瘤。上皮样血管内皮瘤通常是一个诊断困难的问题，特别是在骨中，因为上皮样形态和放射学特征增加了转移癌的可能性。当前通过计算机断层扫描引导技术获得小活检的趋势加剧了这个问题。 EHE 和转移性癌的显着不同的治疗强调了对能够区分这两种实体的特定标记物的需要。目的-确定内皮标记物在区分 EHE 与转移性癌中的相对效用，重点是骨活检。设计-我们在福尔马林固定石蜡包埋的组织中使用免疫组织化学来比较 Fli-1、CD34、CD31、podoplanin 和角蛋白鸡尾酒在治疗中的效用。 13 个 EHE 和 13 个形态相似的骨转移癌。使用Fisher精确检验评估免疫组织化学数据，并计算特异性和敏感性。结果-与转移性癌相比，显着比例的EHE呈Fli-1 (100%)、CD34 (85%)和CD31 (100%)阳性(Fli-1, 15%; CD34, 15%; CD31, 38%) (P < .001, P =分别为 .005 和 P = .01）。然而，这些标记物对于 EHE 并不是 100% 特异性的。细胞角蛋白混合物对转移性癌 (100%) 的染色明显多于 EHE (38%) (P = .01)，但不是 100% 特异性的。不同肿瘤类型之间的足足蛋白免疫染色没有观察到显着差异。结论：-Fli-1 对于区分 EHE 和转移性癌最有帮助。然而，EHE 的任何内皮标记物或癌症的角蛋白混合物都缺乏完全特异性，这表明这些标记物最好联合使用。 （Arch Pathol 实验室医学。2009 年；133：967-972）
Context.-Epithelioid hemangioendothelioma (EHE) is a rare vascular neoplasm of intermediate malignancy. Epithelioid hemangioendothelioma often presents a difficult diagnostic problem, especially in bone, because the epithelioid morphology and radiographic features raise the possibility of metastatic carcinoma. The current trend of small biopsies obtained with computed tomography-guided techniques exacerbates the problem. The markedly different treatment for EHE and metastatic carcinoma underscores the need for specific markers that can differentiate between these 2 entities.Objective.-To determine the relative utility of endothelial markers in differentiating EHE from metastatic carcinoma, with emphasis on bone biopsies.Design.-We used immunohistochemistry in formalin-fixed paraffin-embedded tissue to compare the utility of Fli-1, CD34, CD31, podoplanin, and keratin cocktail in 13 EHEs and 13 morphologically similar carcinomas metastatic to bone. Immunohistochemical data were evaluated using Fisher exact test, and specificity and sensitivity were calculated.Results.-Significant proportions of EHEs were positive for Fli-1 (100%), CD34 (85%), and CD31 (100%) compared with metastatic carcinoma (Fli-1, 15%; CD34, 15%; CD31, 38%) (P < .001, P = .005, and P = .01, respectively). However, these markers were not 100% specific for EHE. Cytokeratin cocktail stained significantly more metastatic carcinomas (100%) than EHEs (38%) (P = .01) but was not 100% specific. No significant difference was observed regarding immunostaining for podoplanin between the tumor types.Conclusions.-Fli-1 is most helpful in distinguishing EHE from metastatic carcinoma. However, the absence of complete specificity of any of the endothelial markers for EHE, or of keratin cocktail for carcinoma, suggests that these markers are best used in combination. (Arch Pathol Lab Med. 2009; 133: 967-972)