脑转移癌患者免疫组化与电镜特征及局部血脑屏障变化的临床意义
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摘要
目的探讨脑转移癌患者免疫组化与电镜特征及局部血脑屏障变化的临床意义。方法选取16例脑转移癌患者的标本蜡块,同时随机选取16例同时期接受治疗的脑胶质瘤患者术后标本蜡块作为对照,对其做CD34、FV-Ⅲ、GFAP、S-100、NSE、NF、MBP和SYN染色,观察各标志物在2组中的表达情况。选取同期接受脑肿瘤手术切除的患者新鲜标本,其中,脑胶质瘤2例,脑转移癌4例,对其做电镜观察,了解血脑屏障连接的变化。结果脑转移癌组和脑胶质瘤组中,CD34和FV-Ⅲ均有丰富表达,其阳性数相比较,差异无统计学意义(P> 0. 05),在脑胶质瘤组织中,GFAP、S-100、NSE、NF、MBP和SYN均强烈表达,但是在脑转移癌组中,几乎不表达,提示脑转移癌中没有胶质膜成分,即没有形成血脑屏障的最基本的结构。电镜扫描表明,脑转移癌患者内皮细胞连结松紧不一,纤细疏松,部分间隙扩大,常见空泡变性,基膜不均一且较薄,与胶质瘤相比毛细血管密度略少,毛细血管周围无胶质细胞终足,瘤细胞之间出现淋巴细胞浸润。结论在脑转移癌组织中,构成血脑屏障的基本物质神经胶质膜缺乏,血管内皮连接不紧密,即其组织中无完整的血脑屏障。
Objective To analyze the clinical significance of immunohistochemistry,electron microscopy and local changes of blood-brain barrier in patients with metastatic brain tumor. Methods 16 paraffin-embedded specimens of brain metastases were selecte,and 16 paraffin-embedded specimens of patients with glioma at the same time were randomly selected as control.CD34,FV-Ⅲ,GFAP,S-100,NSE,NF,MBP and SYN staining were performed to observe the expression of each marker in the two groups. Fresh specimens of patients undergoing surgical resection of brain tumors were selected,including 2 cases of glioma and 4 cases of brain metastases. Electron microscopy was performed to understand the changes of blood-brain barrier connection. Results Both CD34 and FV-Ⅲ in brain metastases and gliomas were abundantly expressed. There was no significant difference in the expression between CD34 and FV-Ⅲ( P > 0. 05). The results showed that gliomas and brain metastases have established neovascularization. GFAP,S-100,NSE,NF,MBP and SYN were strongly expressed in glioma tissues,but in brain metastases,Almost no expression,suggesting that there is no glial cell membrane in brain metastases,that is not the most basic structure of the formation of the blood-brain barrier; electron microscopy showed that. Endothelial cells in patients with brain metastases are loosely connected,slender and loose,part of the gap expansion,common vacuolar degeneration,uneven and thin basement membrane,compared with glioma slightly less capillary density,glial cells around the glial cells The last full,lymphocytic infiltration between tumor cells.Conclusion In brain metastases,the basic substance that forms the blood-brain barrier is lack of glial membrane and vascular endothelial connections are not close,that is,there is no complete blood-brain barrier in their tissues.
Objective To analyze the clinical significance of immunohistochemistry,electron microscopy and local changes of blood-brain barrier in patients with metastatic brain tumor. Methods 16 paraffin-embedded specimens of brain metastases were selecte,and 16 paraffin-embedded specimens of patients with glioma at the same time were randomly selected as control.CD34,FV-Ⅲ,GFAP,S-100,NSE,NF,MBP and SYN staining were performed to observe the expression of each marker in the two groups. Fresh specimens of patients undergoing surgical resection of brain tumors were selected,including 2 cases of glioma and 4 cases of brain metastases. Electron microscopy was performed to understand the changes of blood-brain barrier connection. Results Both CD34 and FV-Ⅲ in brain metastases and gliomas were abundantly expressed. There was no significant difference in the expression between CD34 and FV-Ⅲ( P > 0. 05). The results showed that gliomas and brain metastases have established neovascularization. GFAP,S-100,NSE,NF,MBP and SYN were strongly expressed in glioma tissues,but in brain metastases,Almost no expression,suggesting that there is no glial cell membrane in brain metastases,that is not the most basic structure of the formation of the blood-brain barrier; electron microscopy showed that. Endothelial cells in patients with brain metastases are loosely connected,slender and loose,part of the gap expansion,common vacuolar degeneration,uneven and thin basement membrane,compared with glioma slightly less capillary density,glial cells around the glial cells The last full,lymphocytic infiltration between tumor cells.Conclusion In brain metastases,the basic substance that forms the blood-brain barrier is lack of glial membrane and vascular endothelial connections are not close,that is,there is no complete blood-brain barrier in their tissues.
引文
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[13]郝斌.脑转移瘤应如何治疗[J].抗癌,2016,29(1):22-24.
[14]丁洁,张莹,巫悦,等.麝香、安息香和苏合香对血脑屏障脑区特异性开放作用及其机制[J].中国医院药学杂志,2015,35(4):279-282.
[15]Terrell-Hall TB,Nounou MI,El-Amrawy F,et al.Trastuzumab distribution in an in-vivo and in-vitro model of brain metastases of breast cancer[J].Oncotarget,2017,8(4):83734-83744.
[16]Murrell DH,Zarghami N,Jensen MD,et al.Evaluating changes to blood-brain barrier integrity in brain metastasis over time and after radiation treatment[J].Translational Oncology,2016,9(3):219-223.
[2]王艳芬,刘标,时姗姗,等.甲状腺显示胸腺样分化的癌9例免疫组化与超微病理研究[J].诊断病理学杂志,2016,23(1):10-14.
[3]曹海燕,翟玉龙,孙夏承,等.基于电镜和免疫组化的线粒体数目标志物评估肝癌的初步研究[J].现代生物医学进展,2016,16(14):2646-2650.
[4]李俊,陈飞.放射治疗与分子靶向药物在脑转移瘤治疗中的联合应用效果分析[J].实用癌症杂志,2017,32(1):150-152.
[5]Tsai MH,Hsiao YP,Lin WL,et al.Steatocystoma multiplex as initial impression of non-small cell lung cancer with complete response to gefitinib[J].Chinese Journal of Cancer Research,2014,26(1):5-9.
[6]刘振,张军宁.单发脑转移性癌IMRT与3D-CRT剂量学对比分析[J].实用癌症杂志,2016,31(8):1345-1348.
[7]Adkins CE,Mohammad AS,Terrell-Hall TB,et al.Characterization of passive permeability at the blood-tumor barrier in five preclinical models of brain metastases of breast cancer[J].Clin Exp Metastasis,2016,33(4):373-383.
[8]高山,岳成山,胡勇,等.全脑放疗联合替莫唑胺同期化疗在脑转移瘤治疗中的疗效观察[J].实用癌症杂志,2017,32(2):255-257.
[9]金松龄.47例脑转移癌全脑联合后程三维适形放射治疗疗效分析[J].中国继续医学教育,2017,9(11):117-118.
[10]隋燕霞,蒋娜,解立怡,等.淀粉样变性肾病31例临床病理学分析[J].临床与实验病理学杂志,2014,8(12):1379-1382.
[11]纪海茹,孔维,孔令伟,等.脑缺血再灌注损伤后血脑屏障结构与功能的变化及丁苯酞预处理的干预作用[J].中国病理生理杂志,2014,30(11):2079-2083.
[12]Osswald M,Blaes J,Liao Y,et al.Impact of blood-brain barrier integrity on tumor growth and therapy response in brain metastases[J].Clinical Cancer Research An Official Journal of the American Association for Cancer Research,2016,22(24):6078-6085.
[13]郝斌.脑转移瘤应如何治疗[J].抗癌,2016,29(1):22-24.
[14]丁洁,张莹,巫悦,等.麝香、安息香和苏合香对血脑屏障脑区特异性开放作用及其机制[J].中国医院药学杂志,2015,35(4):279-282.
[15]Terrell-Hall TB,Nounou MI,El-Amrawy F,et al.Trastuzumab distribution in an in-vivo and in-vitro model of brain metastases of breast cancer[J].Oncotarget,2017,8(4):83734-83744.
[16]Murrell DH,Zarghami N,Jensen MD,et al.Evaluating changes to blood-brain barrier integrity in brain metastasis over time and after radiation treatment[J].Translational Oncology,2016,9(3):219-223.
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