A reevaluation of the primary diagnosis of hemangiopericytoma and the clinical importance of differential diagnosis from solitary fibrous tumor of the central nervous system
A reevaluation of the primary diagnosis of hemangiopericytoma and the clinical importance of differential diagnosis from solitary fibrous tumor of the central nervous system
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DOI：
10.1016/j.clineuro.2008.07.010
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发表时间：
2009-01-01
影响因子：
1.9
通讯作者：
Hamada, Jun-ichiro
中科院分区：
文献类型：
--
作者：
Hayashi, Yutaka;Uchiyama, Naoyuki;Hamada, Jun-ichiro
目的：血管外皮细胞瘤是一种罕见的肿瘤，具有较高的复发率和颅外转移率。虽然与血管瘤性脑膜瘤和孤立性纤维瘤（SFT）的鉴别诊断都很重要，但鉴于SFT的良性预后和难以区分SFT与HPC，后者的诊断更为重要。新开发的免疫组化方法揭示了HPC和SFT的特异性免疫组化特征的差异。为了阐明SFTs过去是否被误诊为HPC，我们的研究小组使用最近的免疫组织化学方法重新评估最初被诊断为HPC的组织。我们还比较了这些cases.Patients和方法的临床特点：13个连续的情况下，HPC诊断在金泽大学医院和熊本大学医院之间的1970年和2006年进行了回顾性分析，免疫组化染色CD 34，Bcl-2，上皮膜抗原（EMA），波形蛋白，SIN蛋白，并通过测量MIB-1标记指数（LI）。然后根据免疫组化染色结果对病例进行重新评估和新诊断。结果：13例中4例新诊断为SFT，8例经免疫组化CD 34、Bcl-2和网硬蛋白染色证实为HPC。1例EMA强阳性新诊断为脑膜瘤。12例MIB-1 LI小于1%。在2例HPC和1例脑膜瘤中，MIB-1 LI较高，分别为8%和4%。所有8例HPC均复发，5例HPC患者死于该病。结论：我们的研究表明，一个相对较高的比例，在过去诊断为HPC的肿瘤可能实际上是颅内SFTs。CD 34、Bcl-2和网硬蛋白的免疫组化检查是鉴别诊断的关键。由于SFT的预后比HPC好得多，因此进行细致的免疫组化检查以进行初步诊断是很重要的。(c)2008 Elsevier B. V.保留所有权利。
Objectives: Hemangiopericytomas (HPCs) are rare neoplasms with relatively high rates of recurrence and extracranial metastasis. Though the differential diagnoses from angiomatous meningiomas and from solitary fibrous tumors (SFTs) are both important, the latter diagnosis is somewhat more important in light of the benign prognosis of SFTs and the difficulties in distinguishing SFTs from HPCs. Newly developed immunohistochemical methods reveal differences in the specific immunohistochemical features of HPCs and SFTs. To elucidate whether SFTs have been misdiagnosed as HPCs in the past, our group used recent immunohistochemical methods to re-evaluate tissues that had been originally diagnosed as HPCs. We also compared the clinical features of these cases.Patients and methods: Thirteen sequential cases of HPC diagnosed in Kanazawa University Hospital and Kumamoto University Hospital between 1970 and 2006 were retrospectively analyzed by immunohistochemical staining for CD34, Bcl-2, epithelial membrane antigen (EMA), vimentin, and SIN protein, and by measurement of the MIB-1 labeling index (LI). The cases were then re-evaluated and newly diagnosed based on the results of the immunohistochemical stainings. The clinical course of each case was also evaluated.Results: Four of the 13 cases were newly diagnosed as SFTs and eight were reconfirmed as HPCs, based on the immunohistochemical studies for CD34, Bcl-2, and reticulin staining. One case was newly diagnosed as meningioma on the basis of a strong EMA positivity. The MIB-1 LI was less than 1% in 12 of the cases. In two cases, one case of HPC and the other of meningioma, the MIB-1 LI was relatively high, 8% and 4% respectively. All eight of the HPCs recurred, and 5 of the HPC patients died of the disease. Only one case of the SFTs recurred.Conclusion: Our study suggests that a relatively high percentage of the tumors diagnosed as HPCs in the past may have in fact been intracranial SFTs. Immunohistochemical examinations of CD34, Bcl-2, and reticulin stains are keys for the differential diagnosis. Given that SFTs have a considerably better prognosis than HPCs, it is important to carry out meticulous immunohistochemical examinations for the primary diagnosis. (c) 2008 Elsevier B.V. All rights reserved.