腎上腺外科疾病組織學(xué)分布及臨床病理相關(guān)性研究
發(fā)布時間：2019-05-11 02:11
【摘要】：目的研究北京協(xié)和醫(yī)院20年間診治的腎上腺外科疾病的組織學(xué)分布及流行病學(xué)特點(diǎn)。探尋腎上腺腫瘤組織學(xué)特點(diǎn),探究組織病理學(xué)免疫標(biāo)記物及其與臨床內(nèi)分泌功能的相關(guān)性。方法收錄北京協(xié)和醫(yī)院北京協(xié)和醫(yī)院病案系統(tǒng)可查證的1994年至2013年期間收治為行手術(shù)治療的腎上腺外科疾病患者,篩選病理資料完整的患者3334例,研究腎上腺外科疾病組織學(xué)分布特點(diǎn),了解不同組織學(xué)來源疾病的年齡、性別、手術(shù)方式等流行病學(xué)特點(diǎn)。隨機(jī)抽取北京協(xié)和醫(yī)院泌尿外科確診并明確病理診斷的腎上腺疾病患者95例,對每例患者進(jìn)行詳實的病史采集并獲取病理標(biāo)本。采用免疫組織化學(xué)病理染色研究腎上腺腫瘤皮、髓質(zhì)疾病的鑒別。依據(jù)內(nèi)分泌學(xué)特點(diǎn)隨機(jī)抽取北京協(xié)和醫(yī)院泌尿外科確診并明確病理診斷的腎上腺疾病患者36例,采用免疫組織化學(xué)病理染色研究進(jìn)一步了解皮質(zhì)腫瘤組織學(xué)分布特點(diǎn)及與內(nèi)分泌功能的相關(guān)性。所有患者均自愿參與本研究,并簽署臨床標(biāo)本知情同意書。結(jié)果本研究共收集北京協(xié)和醫(yī)院1994年至2013年這20年間收治的3334例病歷資料完整‘腎上腺外科疾病病例,是目前國內(nèi)最大規(guī)模的腎上腺外科疾病組織學(xué)分布統(tǒng)計。共包含17類病例,其中單病種疾病1%的疾病依照患病率依次為：腎上腺皮質(zhì)腺瘤、嗜鉻細(xì)胞瘤/副神經(jīng)節(jié)瘤、髓樣脂肪瘤、轉(zhuǎn)移癌和節(jié)細(xì)胞神經(jīng)瘤。不同組織學(xué)分布與年齡、疾病、住院天數(shù)、手術(shù)方式存在顯著差異。腎上腺皮質(zhì)腺瘤中無功能腺瘤45.7%,醛固酮增多癥39.5%,皮質(zhì)醇增多癥14.7%,性激素異常0.2%。60歲以上男性組織學(xué)分布具有自身特點(diǎn),應(yīng)有意識排查腎上腺皮質(zhì)細(xì)胞癌、轉(zhuǎn)移癌等相對少見的疾病。既往認(rèn)為無功能的節(jié)細(xì)胞神經(jīng)瘤和髓樣脂肪瘤可能合并臨床功能。皮髓質(zhì)腫瘤的鑒別方面,CgA、MelanA為可靠的腎上腺髓質(zhì)和皮質(zhì)鑒別的免疫組化標(biāo)記物,但Melan-A對腎上腺皮質(zhì)癌的鑒別效力差CYP11B1、CYP11B2和KCNJ5可幫助鑒別具有皮質(zhì)醇分泌功能的病灶,其中KCNJ5的特異性高達(dá)81%,CYP11B2的陰性預(yù)測值可達(dá)92.2%。結(jié)論腎上腺外科疾病的組織學(xué)分布不同,年齡、性別、手術(shù)方式和住院天數(shù)表現(xiàn)各異。腎上腺皮質(zhì)腫瘤以無功能腺瘤為主,其次為正常腎上腺組織中以球狀帶分泌為主的醛固酮腺瘤及束狀帶的庫欣腺瘤為主,髓質(zhì)來源腫瘤以嗜鉻細(xì)胞瘤為主。免疫組織化學(xué)染色較易鑒別皮、髓質(zhì)腫瘤,但對于皮質(zhì)來源腫瘤的組織學(xué)區(qū)分困難,僅能從內(nèi)分泌功能狀態(tài)有一定提示,從功能學(xué)角度定位皮質(zhì)腫瘤來源。CYP11B1、 CYP11B2和KCNJ5均在皮質(zhì)醇腺瘤中高表達(dá)。
[Abstract]:Objective to study the histologic distribution and epidemiological characteristics of adrenal surgical diseases diagnosed and treated in Beijing Union Medical College Hospital in the past 20 years. To explore the histologic characteristics of adrenal tumors and their correlation with clinical endocrine function. Methods 3334 patients with adrenal surgical diseases treated surgically from 1994 to 2013 were selected from 1994 to 2013, which could be verified by the medical record system of Beijing Union Medical College Hospital. To study the histologic distribution characteristics of adrenal surgical diseases and to understand the epidemiological characteristics of diseases from different histologic sources, such as age, sex, surgical mode and so on. 95 patients with adrenal diseases diagnosed and pathologically diagnosed by the Department of Urology of Beijing Union Medical College Hospital were randomly selected. Each patient was collected with a detailed medical history and pathological specimens were obtained. Immunohistochemical pathological staining was used to study the differentiation of adrenal tumor skin and medulla diseases. According to the characteristics of Endocrinology, 36 patients with adrenal diseases diagnosed and pathologically diagnosed by the Department of Urology of Beijing Union Medical College Hospital were randomly selected. The histologic distribution characteristics of cortical tumors and their correlation with endocrine function were further studied by histochemical pathological staining. (2) Immunohistochemical pathological staining was used to further understand the histologic distribution of cortical tumors and its correlation with endocrine function. All patients volunteered to participate in this study and signed informed consent forms for clinical specimens. Results A total of 3334 cases of adrenal surgical diseases admitted to Beijing Union Medical College Hospital from 1994 to 2013 were collected, which is the largest histologic distribution statistics of adrenal surgical diseases in China at present. A total of 17 types of cases were included, of which 1% of the diseases were adrenocortical adenoma, pheochromocytoma / paraganglioma, myeloid lipoma, metastases and ganglioneuroma according to the prevalence rate of adrenocortical adenoma, pheochromocytoma / paraganglioma. There were significant differences between different histologic distribution and age, disease, hospitalization days and surgical methods. In adrenocortical adenomas, 45.7% of nonfunctional adenomas, 39.5% of aldosteronism, 14.7% of cortisol hyperplasia and 0.2% of sex hormone abnormalities were found. The histologic distribution of men over 60 years old had its own characteristics. Adrenocortical cell carcinoma, metastasis and other relatively rare diseases should be consciously examined. It was previously thought that dysfunctional ganglioneuroma and myeloid lipoma might be complicated with clinical function. CgA,MelanA is a reliable immuno-histochemical marker for the differentiation of adrenal medulla and cortical tumors, but the differential effect of Melan-A on adrenocortical carcinoma is poor. CYP11B1,CYP11B2 and KCNJ5 can help to distinguish lesions with cortisol secretion. The specificity of KCNJ5 was 81%, and the negative predictive value of 11B2 was 92.2%. Conclusion the histologic distribution, age, sex, surgical mode and hospitalization days of adrenal surgical diseases are different. The main adrenal cortical tumors were nonfunctional adenoma, followed by aldosterone adenoma with globular zone secretion and Cushing adenoma with fasciculate zone in normal adrenal tissue, and pheochromocytoma was the main medulla-derived tumor. Immunohistochemical staining is easy to distinguish cortical tumors from medulla tumors, but it is difficult to distinguish histologically from cortical tumors. It can only be suggested from the state of endocrine function, and the source of cortical tumors can be located from the functional point of view. CYP11B1, Both CYP11B2 and KCNJ5 were highly expressed in cortisol adenomas.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R736.6
本文編號：2474171
[Abstract]:Objective to study the histologic distribution and epidemiological characteristics of adrenal surgical diseases diagnosed and treated in Beijing Union Medical College Hospital in the past 20 years. To explore the histologic characteristics of adrenal tumors and their correlation with clinical endocrine function. Methods 3334 patients with adrenal surgical diseases treated surgically from 1994 to 2013 were selected from 1994 to 2013, which could be verified by the medical record system of Beijing Union Medical College Hospital. To study the histologic distribution characteristics of adrenal surgical diseases and to understand the epidemiological characteristics of diseases from different histologic sources, such as age, sex, surgical mode and so on. 95 patients with adrenal diseases diagnosed and pathologically diagnosed by the Department of Urology of Beijing Union Medical College Hospital were randomly selected. Each patient was collected with a detailed medical history and pathological specimens were obtained. Immunohistochemical pathological staining was used to study the differentiation of adrenal tumor skin and medulla diseases. According to the characteristics of Endocrinology, 36 patients with adrenal diseases diagnosed and pathologically diagnosed by the Department of Urology of Beijing Union Medical College Hospital were randomly selected. The histologic distribution characteristics of cortical tumors and their correlation with endocrine function were further studied by histochemical pathological staining. (2) Immunohistochemical pathological staining was used to further understand the histologic distribution of cortical tumors and its correlation with endocrine function. All patients volunteered to participate in this study and signed informed consent forms for clinical specimens. Results A total of 3334 cases of adrenal surgical diseases admitted to Beijing Union Medical College Hospital from 1994 to 2013 were collected, which is the largest histologic distribution statistics of adrenal surgical diseases in China at present. A total of 17 types of cases were included, of which 1% of the diseases were adrenocortical adenoma, pheochromocytoma / paraganglioma, myeloid lipoma, metastases and ganglioneuroma according to the prevalence rate of adrenocortical adenoma, pheochromocytoma / paraganglioma. There were significant differences between different histologic distribution and age, disease, hospitalization days and surgical methods. In adrenocortical adenomas, 45.7% of nonfunctional adenomas, 39.5% of aldosteronism, 14.7% of cortisol hyperplasia and 0.2% of sex hormone abnormalities were found. The histologic distribution of men over 60 years old had its own characteristics. Adrenocortical cell carcinoma, metastasis and other relatively rare diseases should be consciously examined. It was previously thought that dysfunctional ganglioneuroma and myeloid lipoma might be complicated with clinical function. CgA,MelanA is a reliable immuno-histochemical marker for the differentiation of adrenal medulla and cortical tumors, but the differential effect of Melan-A on adrenocortical carcinoma is poor. CYP11B1,CYP11B2 and KCNJ5 can help to distinguish lesions with cortisol secretion. The specificity of KCNJ5 was 81%, and the negative predictive value of 11B2 was 92.2%. Conclusion the histologic distribution, age, sex, surgical mode and hospitalization days of adrenal surgical diseases are different. The main adrenal cortical tumors were nonfunctional adenoma, followed by aldosterone adenoma with globular zone secretion and Cushing adenoma with fasciculate zone in normal adrenal tissue, and pheochromocytoma was the main medulla-derived tumor. Immunohistochemical staining is easy to distinguish cortical tumors from medulla tumors, but it is difficult to distinguish histologically from cortical tumors. It can only be suggested from the state of endocrine function, and the source of cortical tumors can be located from the functional point of view. CYP11B1, Both CYP11B2 and KCNJ5 were highly expressed in cortisol adenomas.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R736.6
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