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目的 探讨骨巨细胞瘤的组织发生以及对免疫组化特征与病理分级的关系。方法 应用免疫组织化学技术,对 32例骨巨细胞瘤(GCT)进行了 8种抗体标记检测。结果 32例骨巨细胞瘤中,多核巨细胞和单核基质细胞 CD68均为阳性反应,α-1抗胰糜蛋白酶和溶菌酶两种抗体的阳性反应均较弱;所有病例第Ⅷ因子相关抗原、上皮膜抗原和细胞角蛋白标记在瘤细胞中无阳性表达;全部病例单核基质细胞波形成蛋白和增殖细胞核抗原(PCNA)均为阳性反应,而多核巨细胞几乎都为阴性反应;PCNA增殖指数在骨巨细胞瘤虽随Jaffe 病理分级增高而呈递增趋势,Ⅰ级骨巨细胞瘤的PCNA增殖指数与Ⅱ级和Ⅲ级之间的PCNA增殖指数有显著性差异(P<0.01),但Ⅱ级与Ⅲ级之间无显著性差异(P>0.05),各级相互之间有交叉重叠现象。结论 本文结果提示,骨巨细胞瘤可能起源于骨髓干细胞,并向成纤维细胞和单核-巨噬细胞分化;Jaffe 病理分级与免疫组化的表达不完全一致,但PCNA增殖指数对判断骨巨细胞瘤细胞增殖活性和肿瘤的预后有重要的参考意义。
Objective To investigate the histogenesis of giant cell tumor of bone and its relationship with immunohistochemical features and pathological grade. Methods Using immunohistochemical technique, 32 cases of giant cell tumor of bone (GCT) were detected with eight antibody markers. RESULTS: In 32 cases of giant cell tumor of bone, CD68 was positive in both multinucleated giant cells and mononuclear stromal cells, and the positive responses of both alpha-1 antitrypsin and lysozyme were weak; all cases were associated with factor VIII related antigens. There was no positive expression of epithelial membrane antigen and cytokeratin marker in tumor cells. In all cases, both mononuclear stromal cell wave-forming protein and proliferating cell nuclear antigen (PCNA) were positive, while multinucleated giant cells were almost all negative. PCNA proliferation Although the index of giant cell tumor of bone increased with the increase of Jaffe’s pathological grade, the proliferation index of PCNA of grade I giant cell tumor of bone was significantly different from that of grade II and III (P<0.01). There was no significant difference between grade II and grade III (P>0.05), and there were cross-overs between levels. Conclusion The results of this study suggest that giant cell tumor of bone may originate from bone marrow stem cells and differentiate into fibroblasts and mononuclear-macrophage cells; Jaffe pathological grade is not completely consistent with the expression of immunohistochemistry, but the proliferation index of PCNA is very important for judging bone formation. The proliferation activity of cell tumors and the prognosis of tumors have important reference significance.