Abstract
目的: 探讨骨巨细胞瘤denosumab治疗前后组织学形态与分子表型的改变。 方法: 收集2017年1月至2019年12月就诊于北京积水潭医院的10例经denosumab治疗的骨巨细胞瘤病例,行光镜观察。EnVision二步法免疫组织化学进行H3.3、RANK、RANKL的表达检测,采用Sanger测序法检测H3F3A基因的突变类型。 结果: 10例患者包括女性6例,男性4例,年龄20~62岁(平均年龄34岁)。其中发病部位在骶骨有5例,在股骨、桡骨、胫骨、肩胛骨及髌骨各有1例。术前使用denosumab治疗3~6个月。4例患者分别于术后5、6、11、14个月复发,其余术后经随访4~24个月未见复发。denosumab治疗后骨巨细胞瘤表现为巨细胞消失伴显著的新骨形成。治疗后复发病例表现为经典巨细胞瘤结构的复现并伴有denosumab治疗后的成骨形态。免疫组织化学H3.3染色10例均显示治疗前后一致性的瘤细胞核表达,RANK表达于多核巨细胞与单核细胞,RANKL表达于肿瘤细胞。Sanger测序显示所有病例均存在H3F3A G34W突变。 结论: 通过对denosumab治疗前后骨巨细胞瘤组织形态及RANK、RANKL、H3.3免疫表型辅助分析,显示骨巨细胞瘤的细胞组成,并能对denosumab的治疗机制进行深入理解。.
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More From: Zhonghua bing li xue za zhi = Chinese journal of pathology
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